Playground Accessibility and Usability for Children … › smash › get › diva2:1077678 › ...overall aim of this thesis to identify and explore aspects of playground accessibility

DOCTORA L T H E S I S

Luleå University of TechnologyDepartment of Human Work Sciences

2007:50|: 02-5|: - -- 07⁄50 --

2007:50

Playground Accessibility and Usability for Children with Disabilities

Experiences of children, parents and professionals

Maria Prellwitz

PLAYGROUND ACCESSIBILITY AND USABILITYFOR CHILDREN WITH DISABILITIES

Experiences of children, parents and professionals

MARIA PRELLWITZ

2007

Distribution Department of Human Work Sciences S-971 87 Luleå Sweden

Phone: +46 920 4910 00

Cover photo by: Bernt Larsson

Printing Office at Luleå University of Technology, Luleå, Sweden October 2007

To my family

Why I'm Thankful

I am thankful for a playground where my disability doesn’t matter. I am thankful for the talk tube so my friend and I can chatter. I am thankful I can race my brother as he chooses a different way. I am thankful for a place where no one has to say, “You can’t play here – go away.”

I am thankful for the music panel where I can make new sounds. I am thankful for the tire swing where I can twirl round and round. I am thankful for the pathways that let me play with my friends. I am thankful for the many games where for the first time I can say, “I win!”

I am thankful for the seesaw with the high-back support. I am thankful I can use the slide and the accessible fort. I am thankful for the ramp that leads me to the highest spot. I am thankful for a playground where the fun never, ever stops.

I am thankful for the boat swing that makes me sway. I am thankful there is a place where I can finally play. I am thankful for sensory garden where I can feel and see. I am thankful for a place where everyone accepts me, for me.

Anonymous child

(Reprinted with the kind permission of Boundless playgrounds®)

CONTENT

ABSTRACT............................................................................................................................... 1 ORIGINAL PAPERS................................................................................................................. 3 BACKGROUND........................................................................................................................ 5

Playgrounds: historical background ....................................................................................... 6 Traditional playgrounds..................................................................................................... 6 Contemporary playgrounds................................................................................................ 7 Adventure playgrounds ...................................................................................................... 9 The Swedish context ......................................................................................................... 10

Play....................................................................................................................................... 10 Play - a child’s primary occupation................................................................................. 10 Play and occupational therapy ........................................................................................ 11

Participation in play ............................................................................................................. 13 The playground environment ............................................................................................... 14

Accessibility and playgrounds.......................................................................................... 16 Usability and playgrounds ............................................................................................... 16 The universal design concept ........................................................................................... 17

Legislations and conventions pertinent to accessibility and usability in playgrounds......... 17 THE AIM OF THIS THESIS................................................................................................... 20 METHODS............................................................................................................................... 21

Participants and criteria for selection ................................................................................... 21 Data collection methods ....................................................................................................... 23

Interviews ......................................................................................................................... 23 Interviewing children ....................................................................................................... 23 Questionnaire ................................................................................................................... 24

Data analysis methods.......................................................................................................... 24 Qualitative content analysis ............................................................................................. 24 Phenomenography............................................................................................................ 25 Descriptive statistics ........................................................................................................ 26

Ethical considerations .......................................................................................................... 26 SUMMARY OF RESULTS..................................................................................................... 28

Study I .................................................................................................................................. 28 Attitudes of key persons to accessibility problems in playgrounds for children with restricted mobility: A study in a medium-sized municipality in northern Sweden........... 28

Study II ................................................................................................................................. 29 Are playgrounds in Norrland (northern Sweden) accessible to children with restricted mobility?........................................................................................................................... 29

Study III................................................................................................................................ 30 Usability of playgrounds for children with different abilities.......................................... 30

Study IV ............................................................................................................................... 31 How playground designs influence children with disabilities - parental perceptions. .... 31

METHODOLOGICAL CONSIDERATIONS......................................................................... 33 GENERAL DISCUSSION....................................................................................................... 36

Playgrounds should enable and enhance social interaction............................................ 36 Playgrounds can cause play deprivation, dependency, and stigmatization..................... 38 Lack of awareness of children’s rights ............................................................................ 40 Focus on the environment to enable play......................................................................... 41

Future research ..................................................................................................................... 43

SAMMANFATTNING (IN SWEDISH) ................................................................................. 44 Lekplatsers tillgänglighet och användbarhet för barn med funktionsnedsättningar. Erfarenheter från barn, föräldrar och professionella. ........................................................... 44

ACKNOWLEDGMENTS........................................................................................................ 48 REFERENCES......................................................................................................................... 50

Abstract___________________________________________________________________________

PLAYGROUND ACCESSIBILITY AND USABILITYFOR CHILDREN WITH DISABILITIES Experiences of children, parents and professionals

Maria Prellwitz, Department of Human Work Sciences, Luleå University of Technology, Luleå, Sweden.

ABSTRACTStudies have identified barriers in the physical environment causing restricted participation in play activities for children with disabilities. Therefore, was the overall aim of this thesis to identify and explore aspects of playground accessibility and usability for children with disabilities based on the experiences of children, parents and professionals. The design of the thesis includes four studies examining different aspects of playground accessibility and usability. Data were collected in Study I through interviews with creators of playgrounds (i.e., persons in a municipality responsible for playgrounds), and with users of playgrounds (i.e., children with restricted mobility, and adults that accompany the children to playgrounds). Data in Study II were collected using a questionnaire completed by persons responsible for playgrounds in 41 municipalities of northern Sweden. In Study III, data were collected through interviews of children with different abilities and in Study IV parents of children with disabilities were interviewed regarding playground design. Data from the interviews were analysed qualitatively while data from the questionnaire were analysed using descriptive statistics. Results of the studies showed that persons responsible for playgrounds have not always considered accessibility for children with disabilities. In fact, many of them had never thought about the issue and also expressed a lack of knowledge needed for building accessible playgrounds (I, II). Further, based on children’s experience, playgrounds are important environments for all children, but these are not accessible and usable for all (III). According to the parents, playgrounds do not support play or social interaction for children with disabilities and the design of most playgrounds made their children dependent on adult support. This in turn limited contact with peers and causing the children a sense of being different (IV). To conclude, the results showed that playgrounds are not an accessible or usable environment for many children with disabilities in Sweden. This has affected children with disabilities in negative ways that in turn can cause play deprivation, dependency and stigmatization. The results also indicated that there seems to be lack of awareness regarding children’s rights in society and legislation that governs playgrounds.

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Original papers ___________________________________________________________________________

ORIGINAL PAPERS This doctoral thesis is based upon the following original articles, which will be referred to in the text by their Roman numerals I-IV.

I. Prellwitz, M & Tamm, M (1999). Attitudes of key persons to accessibility problems in playgrounds for children with restricted mobility: A study in a medium-sized municipality in northern Sweden. Scandinavian Journal of Occupational Therapy 6, 166-173.

II. Prellwitz, M, Tamm, M & Lindqvist, R (2001). Are playgrounds in Norrland (northern Sweden) accessible to children with restricted mobility? Scandinavian Journal of Disability Research 1, 56-68.

III. Prellwitz, M & Skär, L (2007). Usability of playgrounds for children with different abilities. Occupational Therapy International 14, 144-155.

IV. Prellwitz, M & Skär, L (Submitted). How playground designs influence children with disabilities - parental perceptions.

The original papers have been reprinted with the kind permission of the publishers.

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BACKGROUNDPlaygrounds are important environments where many children play during their childhood. Playgrounds are designed for children, by adults, to be a place where they are able to perform many different activities¹. Playgrounds are not solely for physical activities. They are also an important place for children to meet and interact with other children. In this respect, playgrounds should be just as important for children with disabilities. However, a recent Swedish survey showed that only about 1% of the countries playgrounds are built with the intent to be accessible for children with disabilities (RBU, 2006). In other words, by not having access to playgrounds a child with a disability can be denied both the opportunity to be in the physical and the social environment that exists on a playground. The phrase “a child’s primary occupation is play” is a statement that has been used in several studies in occupational therapy (Bundy, 1997; CAOT, 1996; Parham & Primeau, 1997; Tanta, Deitz, White & Billingsley, 2005). If play is a child’s primary occupation enabling and enhancing this occupation must be a primary goal for occupational therapists. Therefore, with this goal in mind, occupational therapist should give prime consideration to the environment that can enable this occupation. Since play is the main occupation that takes place on playgrounds, accessibility and usability is a prerequisite if this occupation is to be performed. Why then are playgrounds lacking in accessibility? What are children’s experiences of using playgrounds? How do playground designs influence children with disabilities? These are some questions this thesis will try to answer with its focus on playgrounds accessibility and usability for children with disabilities.

My interest in playgrounds came from a study about children’s attitudes towards children in wheelchairs (Tamm & Prellwitz, 2001). In this study, we interviewed 48 children without disabilities, from 6 to 10 years of age, about what environmental changes that would be needed if a child in a wheelchair were to attend their school or pre-school. The children had different solutions to all potential problems such as ramps, automatic door openers or that they themselves would assist the child using a wheelchair. None of the children foresaw any problems in the indoor environment of their school or pre-school that they could not solve. However, all of the children interviewed, regardless of age, told us that the playground was extremely inaccessible for a child using a wheelchair. Snow in the winter, sand in the summer and a high perimeter around the playground combined to form an insurmountable obstacle for a child in a wheelchair. The results were something we took note of. In other words, the

¹ Both the term activity and occupation are used by occupational therapists to describe participation in life pursuits. However, the term activity refers to human actions that are goal directed but does not necessarily assume a place of central importance or meaning for the person (Pierce, 2001). Whereas, the term occupation is generally viewed as activities that have a unique meaning and purpose in a person’s life and influences how the person spends time and makes decisions (AOTA, 2002). In this thesis these terms will be used according to these definitions.

Background___________________________________________________________________________

children interviewed were conscious of the physical obstacles that were present in their school or pre-school environment and understood that some obstacles would prohibit a child in a wheelchair from playing with the other children. While the children had thought up solutions for accessibility problems related to the classroom environment through the application of technology or by simply lending a hand, none of them had offered a solution to difficulties on the playground. One boy even said, “When we run to the playground they (children using wheelchairs) might as well roll on home”. The results indicated no negative attitudes toward or stigmatisation of children using wheelchairs. In other words, in the interviewed children’s views, only physical barriers prevented children using a wheelchair from playing on the playground and from participating in games with other children in this environment. While this was obvious for these children, it was something I had previously never thought about, which is why I decided to take a closer look at playgrounds and learn more about playgrounds accessibility and usability for children with disabilities.

Playgrounds: historical background

Traditional playgrounds Playgrounds used to reflect theories about how children learn and why they play. One early theory by Spencer from 1873 regarding play expressed that play was an activity that uses up surplus energy. Some of the first playgrounds and even some of those existing today, were built on this theory, designed only as a place to run around and “blow of steam” lacking in provisions for creative activity (Hartle & Johnson, 1993). Another theory by G.T. Patrick from 1916 stated that children’s play was a behavior stemming from the need to relax, a way of rejuvenating after mentally stressful work and that it had no cognitive function (Case-Smith, 2005). On this basis, children were sent out by their teachers to playgrounds by the school to rejuvenate resulting in playgrounds in school yards. In the early 1900s, play was seen as a way of practicing for adulthood, and props used in play were “adult” tools, like tools for cooking, cleaning or hunting. The result of this theory paved the way for playhouses on playgrounds. Another popular theory of the late nineteenth and early twentieth century was that childhood play was a way of acting out the Darwinian evolutionary development (Hall, 1920). This theory gave playgrounds, for example; swing sets, “jungle gyms” and “monkey bars” allowing the children to play like primates. In nineteenth century Germany, physical fitness became a tradition, influencing 1920s playground design to include indoor exercise apparatuses, like different types of balancing beams and climbing structures, in the outdoors (Solomon, 2005).

The beginning of the playground movement in America started in 1885 with an

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idea imported from Germany; a pile of sand that was provided for a “sandgarten” became a play area for children living near a mission in Boston. This play area was well supervised by adults with the purpose of “Americanizing” the children of immigrants, by enticing them to a site where they would be subject to instruction or propaganda, and keeping them off the street (Bell, Fisher, Baum & Greene, 1990). By the early 1900s most major cities in America had playgrounds were the main purpose was crime prevention, i.e., a way to keep children off the street, build character and promote exercise. The role of playgrounds in America at that time stemmed from John Dewey’s theories that portrayed children as miniature adults and that a child’s work was play. Children that did not engage in their profession (play) were believed to stray into delinquency. Another assumption was that physical activities, especially muscle control, were thought to have a moral dimension that would create better citizens (Solomon, 2005). This is the background on how the so-called traditional playgrounds came about. Some of these types of playgrounds still exist in schools and public parks today.

Traditional playground

Contemporary playgrounds Towards the middle of the twentieth century, new theorists, mostly in the area of psychology, like Sigmund Freud, Jean Piaget, and M.J. Ellis, discussed play as a behavior in its own right and viewed play as important for children’s social, cognitive and affective development. For example, according to Ellis, traditional playgrounds were no more than a combination of large playthings placed together in one location to provide opportunities for gross motor activities by

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simulating, in galvanized steel, some primitive jungle setting (Brown & Burger, 1984). The outcome of the criticism of traditional playgrounds resulted in the design and construction of what is now called contemporary playgrounds. These playgrounds are designed with novel forms, textures and different heights in aesthetically pleasing arrangements. In the contemporary playgrounds, color and texture, such as fiberglass and, later wood, became important features of playground design. During the 1950s and 1960s, these contemporary playgrounds became popular and had imaginative and artistic structures designed in different themes such as western or nautical, with playground equipment shaped to resemble animals or vehicles with the intention of pleasing stimulus-seeking children. One belief about play was that providing a stimulating environment could affect the amount of usage and type of play that took place in that environment. Children’s interest in playing on the playground should therefore increase if the playground had a creative design and complex materials that could be used in different ways (Hartle & Johnson, 1993). However, contemporary playgrounds still included much of the same kind of equipment, like jungle gyms and monkey bars, similar to traditional playgrounds but created with a different design and different materials. The new features of contemporary playgrounds was the inclusion of multifunctional equipment (i.e., one apparatus could have several play functions). An example is the slide that extends from a multileveled wooden structure shaped like a tower with a bridge to another structure with a ladder. Contemporary playgrounds are the most common playgrounds in the western world today (Solomon, 2005).

Contemporary playground

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Adventure playgrounds The first adventure playground was built in Copenhagen, Denmark during World War II. The idea came from C.Th. Sørensen, a landscape architect who had observed that children played everywhere except in the traditional playgrounds he had built (Solomon, 2005). These playgrounds were also called “junk playgrounds” because they started out with used material like scraps of wood and fragments of metal, making these playgrounds perfect solutions for countries at war. At these playgrounds, the children were encouraged to build structures but also given the opportunity to choose freely what they wanted to do. These playgrounds were usually in an enclosed area and had a supervisor or play leader making different activities possible, such as gardening and cooking in addition to digging and building (Bell, Fisher, Baum & Greene, 1990). Adventure playground became popular in Great Britain during the 1950s embodying the more progressive theories of psychologist Erik Homburger Eriksson on the sociability of play, and of Jean Piaget on play and cognitive development. Lady Allen of Hurtwood, co-founder of the World Organization for Early Childhood Education (OMEP) with Alva Myrdal, was the person that introduced Adventure playgrounds to Great Britain after World War II. In the 1970s, she also created an adventure playground for “handicapped children”. Currently there are about 1,000 adventure playgrounds in Europe, most of them are in Germany, England, the Netherlands, France, and Denmark. Germany alone has over 400 adventure playgrounds (Solomon, 2005). In Sweden today, there are four (IPA, 2007), and in the United States, there are two adventure playgrounds (Arieff, 2007).

Adventure playground

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The Swedish context In early twentieth century Sweden, a political awareness of children’s situation in cities started to grow, as people started to move in from the country into cities and traffic started to become a problem. In order to keep children off the streets and city parks, playgrounds were created. During the 1920s and 30s many playgrounds were built in larger cities (Lenniger & Olsson, 2006). In the 1970s, interest in the physical planning and research for playgrounds increased significantly, with the goal of creating innovative and creative playgrounds. Legislation became very specific about design details, such as suitable surface material, minimum size, and walking distances from front door to playground. The National Board of Health and Welfare (Socialstyrelsen) was made responsible for examining the playground equipment from a pedagogical and safety perspective. A special council within The National Board of Health and Welfare was formed in 1971 to work only with issues regarding play and play equipment. The council’s mandate was to promote play for children’s development and to work towards the construction of playgrounds and playground equipment of high quality. The council suggested supervised adventure playgrounds with movable equipment and during the 1970s Sweden had over 150 supervised adventure playgrounds. The council also wrote in a report that traditional playgrounds could be seen as a monument to how little designers and builders of playgrounds know about children and play (Handboken Bygg, 1981; Sveriges kommuner och landsting, 2006). However, during the reorganization of The National Board of Health and Welfare in the early 1980s the council was found to be redundant. Almost thirty years has passed since the council commented on playground designs, but according to Lenning and Olsson (2006), the playgrounds in Sweden still look the same. Only the color on some playground equipment has changed. This historical background implies that few changes on playgrounds actually have been made since the 1970s or even earlier, in Sweden.

Play

Play - a child’s primary occupation According to United Nations (1989) Convention on the Rights of a Child, play is a central feature of children’s everyday life. An essential part of play is the child’s interaction with peers and the environment. Play is more than being a recreational activity that children engage in, it is an occupation with a range of potential benefits (Sandberg, Björck-Åkesson, & Granlund, 2004). Theories regarding play can be divided into classical theories and modern theories of play. Classical theories try to explain the existence and purpose of play while modern theories attempt to explain the role of play in child development (Mellou, 1994). Modern theories include Mead’s (1934) sociocultural theory, which states that children learn social norms and values through play with other

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children and Bateson’s (1955) theory, which states that play is a key element of learning. Psychodynamic theorists (Freud, 1961; Erikson, 1985) explain the role of play as a way for children to achieve a level of wish-fulfillment or master traumatic experiences. For cognitive developmental theorists like Piaget and Vygotsky (Piaget, 1962; Vygotsky, 1966) play is a cognitive process and a voluntary activity that contributes to cognitive development such as problem solving and creative thought. According to the arousal modulation theory (Ellis, 1973) play is intrinsically motivated and a stimuli seeking behavior. After looking at play from different theoretical perspectives Barnett (1991) concluded, that play is central to cognitive, social, and emotional development in children. The outdoor environment, like the school or neighborhood playground, is an especially important location for play for most children. It is a domain that is less parent-dominated than the indoor environment, an environment to explore, a source of novelty, and most of all, a venue for interaction with peers (Betsy, 2001). In outdoor activities, play is also viewed as a way for a child to experience a feeling of competence and a sense of control over the environment (Moore, Goltsman, & Iacafano, 1987).

Play is complex, and the complexity lies in the many different ways in which children play. It is also a natural part of a child’s life, with many opportunities to engage in play and interact with peers (Zinger, 2002). A child with disabilities, on the other hand, may not have as many opportunities to engage in play activities, especially outdoors. Research has shown that a child with disabilities have a difficult time finding peers to play with, and, that relationships to friends of the same age are limited or non existing (Segal, Mandich, Polatajko & Cook, 2002a; Skär, 2002). In playgrounds children with disabilities are observed playing alone or with an adult more often than children without disabilities (Nabors & Baldawi, 1997). In Sweden, approximately 225,000 children and youth (up to 17 years of age), or 13% of all children and youths in that age group, have some kind of disability (Hjälpmedelsinstitutet, 2002). This indicates a need for more knowledge about how the possibilities are for children with disabilities to engage in play on the playground and how they perceive play in this setting.

Play and occupational therapyOccupational therapists direct their expertise to a range of human occupations (AOTA, 2002; Kielhofner, 2002). Play is one area of human occupation that occupational therapists work with to promote an individual, group or population to engage in (AOTA, 2002). The importance of play and ways to view play within occupational therapy has changed through the years (Case-Smith, 2005; Stagnetti, 2004). Already in the early years of occupational therapy, play had an important role in the profession (Parham & Primeau, 1997). In the early 1920s

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Adolph Meyer wrote about the big four, referring to work, play, rest and sleep. These four areas were considered important for people to be able to handle the activities and demands of life. Another occupational therapist, Eleanor Slage, wrote in 1922 how play was essential for living. During this time occupational therapists used play for a variety of reasons such as diversion, development of skills, or for remedial reason. However, towards the 1950s play became viewed as secondary to learning and as an “unscientific” approach. Play per se lost importance for occupational therapists, and greater emphasis was given to more “scientific” approaches like measuring motor skills or adapting equipment. To be referred to as “play ladies” as they had previously been was now something occupational therapists found embarrassing (Couch, Deitz & Kanny, 1997). According to Kielhofner and Burke (1977), this change of focus was due to external pressure on the profession to adopt a more scientific approach.

Mary Reilly brought play back into the forefront of occupational therapy for children, with her occupational behavior frame of reference (Parham & Primeau, 1997). According to her, play was important for the development of skills needed in adulthood and in the human struggle for mastery, achievement and adaptation. The struggle for mastery within one’s environment was seen as especially important for people with disabilities (Reilly, 1974). Reilly was inspired by the arousal modulation theories that emerged in the 1960s and 70s, which proposed that play was a stimulus seeking behavior associated with exploration and that it was through play that children prepared for becoming adults (Case-Smith, 2005; Stagnetti, 2004). These arousal modulation theories also gave rise to the contemporary playground design. One of the more recent theories regarding play within occupational therapy is “the model of playfulness” (Bundy, 1997) which states that play should be understood as a process or attitude that a child brings to a situation and the attitude of play (playfulness) is determined by the presence of intrinsic motivation, internal control, the freedom to suspend reality and social play cues. However, regardless of model, play is theorized and viewed by occupational therapists as an area of occupation and the primary occupation of childhood.

Play as an occupation relates to different kinds of activities and an occupational therapist can offer assessments to identify a child’s strengths and limitations in an activity, as well as interventions to enable engagement in activities. An occupational therapist can also assess how the environment influences the performance of an activity (CAOT, 1996; Rogers & Ziviani, 1999). Adaptation of activities is another part of occupational therapy interventions and requires an understanding of the child’s abilities and of the environment where the occupation takes place (Rast, 1986; Rogers & Ziviani, 1999). However, studies within occupational therapy focus for the most part on children with disabilities limitations brought about by the child’s physical disabilities. And that these

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disabilities limit the children’s ability to explore, interact with, and master their environment and may consequently deprive them of a normal childhood (Blanche, 1997; Case-Smith, 2005; Knox 1999). Fewer studies focus on how the environment influence or limits performance of activities, for example play, for children with disabilities. Considering this, occupational therapists needs to explore environmental aspects more in detail in order to enhance occupational performance.

Over time, the focus of every profession changes and evolves, along with society. To remain viable, a profession needs to develop and adapt to meet the needs of society. This is also true for occupational therapy, which has traditionally dealt mostly with the need of individual clients. With its previous orientation towards the “medical” way of practice, occupational therapists have worked more with health care professionals than with people interested in planning enabling environments. However, by the later half of the 1990s focus has moved towards natural settings and towards community-based services (Heah, Case, McGuire & Law, 2007). New legislation, like the Americans with Disability Act (ADA, 2000) or the Swedish Government bill (Regeringens proposition, 1999/2000:79) that required a national action plan for disability politics, has resulted in a change within occupational therapy toward a community focus. Also the focus on play seems to have shifted to support children’s intrapersonal skills and environmental factors more, in order to improve the children’s performance in play. This shift can be of importance for the professions future and for what type of service occupational therapists can offer in the future. This indicates a greater need of knowledge, of environmental factors as well as children with disabilities subjective experiences of this environment as a group if a community focus is part of the future of the profession.

Participation in play The ability to participate in meaningful occupations is believed to have a big influence on a person’s health (CAOT, 1996). Occupational therapists recognize that health is supported and maintained when people are able to engage in occupations and perform activities that allow for participation in the home, school and society (AOTA, 2002). Participation in activities is also considered to be a vital part of children’s development (de Winter, Baerveldt & Kooistra, 1999; King, Law, King, Rosenbaum, Kertoy & Young, 2003). Children with disabilities are likely to have limited participation in activities (Heah, Case, McGuire & Law, 2007). According to Simeonsson, Carlsson, Huntington, Sturtz-McMillan and Brent (2001) increased participation for children without disabilities correlates with a number of positive physical, psychological, and social outcomes. Therefore, it is important that children with disabilities are

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presented with the same opportunities to benefit from the same potential positive outcomes.

In recent years, research have shown that disability status only has minor impact on a child’s participation in occupation, while the environmental factor has a stronger influence on children with disabilities participation (Baker & Donnelly, 2002; Bedell, Haley, Coster & Smith, 2002; Law, Finkelman, Hurley, Rosenbaum, King, King & Hanna, 2004; Sloper, Turner, Knussen, & Cunningham, 1990). Other studies (Heah, McGuire & Law, 2007; Simoensson, Leonardi, Lollar, Bjorck-Akesson, Hollenweger & Martinuzzi, 2003) have concluded that it is not a child’s diagnosis that mainly affects his or her participation. It is instead because of barriers in the environment. Therefore, according to these studies, more focus should be given on environmental factors.

The concept of participation is central in the International Classification of Functioning, Disability, and Health [ICF] (World Health Organization, 2001), which provides an international and inter-professional scientific basis for understanding and studying health that may in turn increase cooperation between health care professionals, client organizations, and other sectors in society (Hemmingsson & Jonsson, 2005). In the ICF, the environment is especially addressed where environmental factors can enable or hinder participation. The central role of the environment in the ICF stems from the social model of disability that was presented by the disability rights movement. The social model focuses on the environment as the main reason for a disability, arguing that disability is not a condition within the person instead it is something created by society (Barnes, Mercer & Shakespeare, 1999; Imre, 1997; Oliver, 1996). An aspect seldom discussed within the disability rights movement, nevertheless something the social model is being critiqued for, is if a change in the physical environment can completely compensate for all performance limitations, since some impairment will continue to exclude people with disabilities from some activities even when barriers are removed (French, 1994). Using occupational therapy models that address the person and the occupation as well as the environment might therefore be a broader way to view how to enable occupational performance and participation.

The playground environmentIn the theory formation of occupational therapy, the relation between person and environment is by tradition of central significance as a strategy to promote occupational performance (Law, Cooper, Strong, Stewart, Rigby & Letts, 1996). Models in occupational therapy (Christiansen & Baum, 2005; Hagedorn, 2000; Kielhofner, 2002; Law et al, 1996) describe occupational performance as a result of a complex interaction among people, environment, and occupation. All occupations, including play, are carried out in an environment that provides a

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context that is external to the person. Environments consist of physical elements, both built and natural, and social influences. Therefore, is the environment, the context for all performance, and depending on how the environment influences a person it can enable or hinder occupational performance.

In the 1950s, O’Reilly (1954) wrote about the interaction between person and environment, and stated that one of the most important tasks of occupational therapists is adapting a person to a suitable environment in order to improve the person’s health and minimize stress. However, the environment was not emphasized in occupational therapy literature until the 1970s and 1980s (Law et al, 1996). The interaction between the environment and a living system and how the environment could provide an optimal level of stimulation for clients were central issues in the Model of Human Occupation [MOHO] from 1980 (Kielhofner & Burke, 1980). Since then, occupational therapy theories and research has moved from a biomedical model to a transactive model of occupational performance. In recent years, a number of occupational therapy models have been developed (CAOT, 1997; Christiansen & Baum, 2005; Hagedorn, 2000). Each model has unique features, but they all emphasize the understanding of occupational performance through the identification and analysis of elements or conditions in the environment (Letts, Rigby & Stewart, 2003). One of these models, the Person-Environment-Occupation [PEO] model (Law et al, 1996) stems from a theoretical model that was presented by the environmental psychologist Lawton (1980) that states that there should be a balance between the capacity of the individual and the demands of the environment in order to create a harmonious relationship between person and environment. This balance, according to Lawton’s docility hypothesis, can be achieved in one of two ways – by adapting human capacity to the demands of the environment, or by adapting the environment to human capacity. Lawton considers further that people with lower capacity than normal are considerably more sensitive to the demands of the environment than individuals with higher capacity, and that there should therefore be a balance between the capacity of the person and the demands of the environment.

What makes occupational therapy models different from Lawton and other environmental behavior models is the inclusion of occupation as essential to understanding the person–environment relationship. Various models in occupational therapy view the environment broadly, including cultural, social, physical and temporal dimensions, and propose that the environment can either enable or hinder occupational performance (Christiansen & Baum, 2005). When occupational therapists apply any of these models, they can assess how the environment influences occupational performance and consider how the environment can be used or modified to enable occupational performance. Necessarily, in planning of enabling environments, these models link

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occupational therapy with other professions that have parallel person-environment interests, such as social scientists, architects and interior designers (Letts, Rigby & Stewart, 2003). If for example, the PEO model is to be applied to children with disabilities and play on playgrounds, more knowledge regarding the occupation play is needed.

Accessibility and playgrounds Accessibility can be seen as representing the person-environment interaction and can be defined as the encounter between the functional capacity of a person or group and the demands of the physical environment. By this definition accessibility refers to compliance with official norms and standards and should be viewed objectively (Iwarsson & Ståhl, 2003). However, in the context of playgrounds, accessibility has been mainly focused on the addition of ramps and transfer stations. According to the accessibility guidelines of the Americans with Disabilities Act (ADA, 2000), at least one of each type of play equipment must be on an accessible route and at least 50% of the equipment on the playground should be accessible. Nevertheless, research shows that fewer then 10% of children with disabilities can use the ramps and transfer stations that were added to make playgrounds more accessible (Christensen & Morgan, 2003). In Sweden, the law regulating playgrounds only states that playgrounds should be accessible (SFS 1987:10). This is an indication that the efforts of building accessible playgrounds in the U.S. have not been successful. In Sweden there is a lack of research done regarding playgrounds accessibility.

Usability and playgrounds In recent years occupational therapy research has focused not only on environmental accessibility but also on usability (Carlsson, 2004; Fänge & Iwarsson, 2005a; Fänge & Iwarsson, 2005b; Iwarsson & Ståhl, 2003; Reid, 2004). According to Iwarsson and Ståhls definition is usability more subjective then accessibility and implies that a person should be able to use i.e., to move around, be in and use an environment on equal terms with others. Usability does not focus on official standards and guidelines, instead it takes users’ subjective evaluation of performing an activity into account. Usability in a specific environment must be based on the functional capacity of an individual or group, the environment based on user evaluation, and the activities to be performed by an individual or group in the environment (Iwarsson & Ståhl, 2003). These factors of usability must be analyzed together to determine the extent of occupational performance in the environment. This illuminates the importance of the children’s experience of this environment, however, more research about children with disabilities experiences of performing activities on playgrounds is needed in order to evaluate playgrounds usability. Experiences that could give occupational therapists an indication on how to enable play in playgrounds for children with disabilities.

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Background___________________________________________________________________________

The universal design concept Environmental interventions on a societal level have recently gained increased attention within occupational therapy research in an effort to promote the integration of persons with disabilities into society (Dahlin Ivanoff, Iwarsson & Sonn, 2006). In this light, the concept of universal design has gained increased interest within occupational therapy (CAOT, 2003). Universal design is defined as the design of products and environments to be usable by all people; to the greatest extend possible, without adaptation or specialized design (Christophersen, 2002; Preiser & Ostroff, 2001). The concept was developed by a group of architects, product designers, engineers, and environmental design researchers in America and is linked to a set of seven principles that offers guidance for designers to better combine features that meet the needs of as many users as possible. The seven principles are: (1) Equitable use; (2) Flexibility in use; (3) Simple and intuitive use; (4) Perceptible information; (5) Tolerance for error; (6) Low physical effort; and (7) Size and space for approach and use.

Even before the concept of Universal Design, there have been a variety of related concepts like “barrier-free design”, “accessible design”, “design for all”, and “inclusive design”. The first two concepts precede the universal design concept and carry a negative connotation due to their focus on accessibility for disabled people. The “design for all” concept, according to Ostroff (2001) is the preferred concept in Europe while “inclusive design” is preferred in the United Kingdom. According to Hansson (2006), the two latter concepts are synonymous to universal design, but the choice of one concept over the other is usually based on tradition or area of work. In Canada occupational therapists collaborate with developers in designing homes based on universal design (Ringaert, 2002). Universal design supports the occupational performance of many people regardless of ability and could therefore be seen as an emerging field for occupational therapists since it enables the creation of environments that are usable to more people regardless of ability without the need for adaptation (CAOT, 2003).

Legislations and conventions pertinent to accessibility and usability in playgrounds

In Sweden, the National Board of Housing, Building, and Planning (Boverket) is responsible for building regulations and supporting the development of accessible public places. The legislation that governs the building of playgrounds is the Planning and Building Act (SFS, 1987:10). Section 15 of the legislation on public spaces states: “that the site can be used by persons with limited mobility or orientation capacity, unless the terrain and other circumstances makes it unnecessary”. In 2001, an amendment to this legislation

17

Background___________________________________________________________________________

that reinforced section 15 from “that a site can be used by…” to “that a site shallbe used by…” was added. This new amendment also added to the Planning and Building Act of 1987 a new section, section 21a, that states “easily eliminated obstacles to the accessibility and usefulness of the premises and the places for persons with limited mobility or orientation capacity shall be removed to the extent required by provisions issued under law” (SFS 2001:146). With this new section added to the legislation, the National Board of Housing, Building, and Planning issued policy and general recommendations (BFS 2003:19) on what is termed as “easily eliminated obstacles” in outdoor public spaces. The general recommendations issued regarding easily eliminated obstacles in playgrounds include changing of the groundcover, replacing existing playground equipment that is difficult to access and adding signs or symbols. The goal of the policy and general recommendations in the BFS 2003:19 is that, by the end of 2010, all easily eliminated obstacles in public spaces outdoors should be eliminated so that the goal of Sweden’s National Action Plan on Handicap Politics (Regeringens proposition, 1999/2000:79) will have been met. Shortly after the issuing of BFS 2003:19, the National Board of Housing, Building, and Planning issued another policy and general recommendation (BFS 2004:15) regarding public spaces other then buildings. This policy is directed towards new constructions and is more precise regarding accessibility and usability for persons with limited mobility or orientation capacity in public spaces other than buildings. Therefore, regardless of whether a playground is old or new, there are laws and legislation stating that this environment should be accessible and usable for all children.

Three United Nations conventions include principles of accessibility in their statements. The Standard Rules on the Equalization of Opportunities for Persons with Disabilities (United Nations, 1993), accessibility to the physical environment being one of its target areas, states that “for persons with disabilities of any kind, States should introduce programs of action to make the physical environment accessible”, and that “accessibility requirements should be included in the design and construction of the physical environment from the beginning of the design process”. In the Convention on the Rights of the Child, (United Nation, 1989) article 2 states that a child should be protected against any form of discrimination, and article 23 states that a child with disabilities shall be ensured access to recreational opportunities in a manner conducive to the child’s achieving the fullest possible social integration and individual development. In the Convention on the Right of Persons with Disabilities (United Nation, 2006), article 2 includes universal design in its definitions, and, in article 3, accessibility, “respect for the evolving capacities of children with disabilities and respect for the right of children with disabilities to preserve their identities”are presented as general principles. Despite these laws and conventions, research indicate that playgrounds accessibility and usability has not been successfully

18

Background___________________________________________________________________________

implemented as of yet. Why these laws, legislations and conventions have not been followed to a greater extent is a question that needs to be studied more.

To sum up, the background describes why we build playgrounds and how designs of playgrounds change depending on our understanding of why children play. The background also points to the importance of play for children’s development. However, children with disabilities have a difficult time playing on equal terms since playgrounds seem to be inaccessible, despite legislations and conventions. Why few playgrounds are built with the intent to be accessible and how lack of accessibility and usability in playgrounds affects children with disabilities are questions scarcely studied. Occupational therapists and other professionals could help to support the occupational performance of play in playgrounds for children with disabilities if these questions were answered. By identifying and exploring aspects important to make playgrounds accessible and usable, experiences from children, parents and professionals could help the occupational therapists promote play and participation of children with disabilities in playgrounds.

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Background___________________________________________________________________________

THE AIM OF THIS THESIS The overarching aim of this thesis was to identify and explore aspects of playgrounds accessibility and usability for children with disabilities.

The specific aims were: To explore the attitudes to accessibility problems in playgrounds among two groups of key persons: ”creators” and ”users of playgrounds” in a me-dium-sized municipality in northern Sweden. (Paper I)

To investigate the accessibility of playgrounds to children with restricted mobility in the northern half of Sweden. (Paper II)

To better understand how children with different abilities use playgrounds to engage in creative play and interact socially with their peers. (Paper III)

To describe parent’s perception of how playground designs influence their children with disabilities. (Paper IV)

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Methods___________________________________________________________________________

METHODSThe overall design of this thesis was emergent, i.e., different strategies were used depending on the research questions being asked and the questions asked were derived from the results of the preceding study (Lincoln & Guba, 1985). The four studies in this thesis can be described as both explorative and descriptive. The aim of the explorative studies (Studies I and II) was to gather as much information as possible on the specific problem area about which little is known. In Study I, the research question was a way to find out more about this specific area from one municipality. The results from this study were used to form the questionnaire in Study II to determine if the results from Study I were applicable outside the investigated municipality. The aim of the descriptive studies (Studies III and IV) was to enable a more comprehensive examination of the problem area taken from different perspectives. In Study III the aim was to better understand the subjective experience of children with different abilities on usability of playgrounds. The results from this study led to a further exploration of how children with disabilities were influenced by the playground designs by interviewing parents in Study IV. The purpose of using different designs and methods in the thesis is according to both Lincoln and Guba, (1985) and Denzin and Lincoln’s (1994) triangulation strategy. Using multiple sources of information or points of view (i.e., triangulation) reflects an attempt to secure an in-depth understanding of the phenomenon in question.

Participants and criteria for selection In total 90 persons participated in these studies. The selection of participants was done by using different inclusion criteria depending on the aim of each study. Table I shows an overview of the number of participants for each study.

Table 1: Participants, data collection methods and data analysis methods in study I-IV Participants Data collection

methodsData analysis methods

Study I n=11 key persons (5 creators of playgrounds and 6 users of playgrounds

Semi-structured interviews

Contentanalysis

Study II n=41 persons responsible for playgrounds Questionnaire Descriptivestatisticalanalysis

Study III n=20 children, with different abilities, (5 with restricted mobility, 5 with severe visual impairment, 5 with moderate developmental disabilities and 5 without disabilities).


Contentanalysis

Study IV n=18 parents of children with restricted mobility or sever visual impairment or moderate developmental disabilities.


Phenomeno- graphicanalysis

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Methods___________________________________________________________________________

Study I: In this study, the method for selecting the participants was done by a convenience sampling method called snowball sampling (Polit & Hungler, 1999). The five creators of playgrounds were chosen through the first informant who was asked to identify four other participants that met the criteria (i.e., persons within the municipality who created playgrounds). In such a way, the creators of playgrounds were selected to participate in the study. The six users of playgrounds were known through a previous research project (Tamm, Skär & Prellwitz, 1999) and were contacted directly, since they had previously given the author permission to contact them at a later date. The participants were three children with restricted mobility, (age between 7 and 11 years), one parent, one personal assistant and one school assistant. All of them lived in the municipality.

Study II: In this study, the 54 municipalities that constitute the region of Norrland were contacted for participation, and a questionnaire was sent to the person responsible for playgrounds in each municipality. The response rate was 76%, or 41 municipalities, replied to the questionnaire. Thirteen municipalities did not participate in the study. Two municipalities replied that they could not answer the questionnaire since they had handed over responsibility for playgrounds to road or residents’ associations. In two municipalities the person in charge of playgrounds had recently been appointment and did not consider him/herself to have sufficient information to be able to reply to the questionnaire. Nine municipalities did not respond to the questionnaire despite reminders.

Study III: Twenty children, 9 girls and 11 boys, from 7 to 12 years of age, with different abilities (5 children with restricted mobility, 5 children with severe visual impairment, 5 children with moderate developmental disabilities, and 5 children without disabilities) participated in the study. The children included in the study had good communicative abilities and the children with restricted mobility, used an assistive device. The children with restricted mobility and moderate developmental disabilities were selected with the assistance of two occupational therapists and psychologists from two Children’s Rehabilitation Clinics in northern Sweden. The children with severe visual impairment were selected with the assistance from the regional coordinator of the Swedish Association of Visually Impaired Youth. The children without disabilities were randomly chosen with the assistance of an elementary school teacher who requested permission from their parents by sending a letter asking for permission to have their children participate in the study.

Study IV: Eighteen parents of children with disabilities from 7 to 12 years of age participated in the study. Six parents had a child with moderate developmental disabilities, six parents had a child with restricted mobility where the use of assistive device was necessary, and six parents had a child with severe

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Methods___________________________________________________________________________

visual impairment. The parents of children with restricted mobility and moderate developmental delays were selected with the assistance of two occupational therapists and psychologists from two children’s rehabilitation clinics in northern Sweden. The parents of children with visual impairment were selected with the assistance from the Swedish Association of Visually Impaired Youth. Fifteen of the 18 parents also had their children partake in Study III.

Data collection methods Interviews were conducted for Studies I, III and IV while, in Study II, a questionnaire was used.

InterviewsThe purpose of research interviews is to obtain descriptions of the lifeworld of the subject with respect to interpretation of their meaning. Semi-structured interviews have a sequence of themes to be covered that allow for follow up questions to answers and stories given. The interview can be seen as a conversation between two persons about a topic of mutual interest (Kvale, 1996). In Studies I, III and IV, semi-structured interviews using an interview guide with an outline of topics to be covered were used in order to capture the respondent’s experiences and perceptions of the topics under study and in order to collect comparable data (Holloway & Wheeler, 2002).

Interviewing children Interviewing children either formally or informally is an extremely difficult procedure. One problem is that children have been known to be compliant to what they interpret as being required of them. They also have a problem resisting suggestibility, in that they tend to act on what they perceive others are suggesting (Krähenbuhl & Blades, 2006; Zajac & Hayne, 2003). Several researchers have found that when an interview situation starts with a broad opening question, it gives the children opportunity to choose what they want to tell. If the interview is followed by open questions this will improve the accuracy and reliability of the children’s answers. Open questions starting with ‘who’, ‘what’, ‘when’, ‘why’, etc. is advocated (Holliday, 2003; Holliday & Albon 2004; Krähenbuhl & Blades 2006; Peterson & Biggs, 1997). For children with developmental delays free recall questions and open ended questions have proven even more important since probing and closed questions have shown to give lower levels of accuracy (Henry & Gudjonssson, 2003).

In Studies I and III, children from 7 to 12 years of age were interviewed. In both studies, a broad opening question with follow up questions started the interviews. These follow up questions were one way to see if the child keeps the same opinion or perception of a situation (Doverborg & Pramling 2000). The

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Methods___________________________________________________________________________

children where interviewed in a quiet and familiar setting, either at home or at their school, so that they would feels secure, could concentrate, and would not lose interest.

Questionnaire The data collection method used in Study II, was a self-administrated questionnaire. Using questionnaires is advantageous in that it is an inexpensive way of collecting data. A questionnaire also gives the opportunity to cover a total population (Polit & Beck, 2004). A questionnaire was sent to all the municipalities of the five counties that constitute the region of Norrland. The questions were formulated on the basis of Study I and were short and easy to understand. The questionnaire contained 8 questions with fixed answer alternatives and 5 open ended questions. The response rate can be considered relatively high (76%) and gives a good indication of the situation in all the municipalities in Norrland.

Data analysis methods In this thesis, qualitative content analyses (Studies I and III) and a phenomenographic interpretation (Study IV) were used to analyse the interviews. The answers to the questionnaire (Study II) were analysed using descriptive statistics. The choice of analysis method was based on the aim of the studies. In Studies I and III, the aim was to describe the content of the interviews. In Study II, the aim was to investigate how many playgrounds in Norrland were accessible and in Study IV, the aim was to describe the parents’ different perceptions of the phenomenon.

Qualitative content analysisContent analysis is a method for analysing data that can be traced back to before World War II when it was mainly a way to critique journalistic endeavours. During World War II, content analysis was used to analyze propaganda (Krippendorff, 1980). Content analysis has no particular methodological roots or disciplinary traditions (Polit & Beck, 2004), but it is often referred to as a way of identifying core consistencies and meaning in qualitative data. This is done by finding patterns or themes within the data (Patton, 2002). Content analysis of the interviews was used in Studies I and III. In Study I, interviews with thecreators and the users were analysed separately. In Study III, interviews with the children, regardless of ability, were analysed together. The goal of the analysis was to identify primary patterns in the data, and the purpose for choosing this method was to gain an increased understanding and knowledge of the chosen perspective of this study.

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Methods___________________________________________________________________________

The processes of analysing the two studies were similar. In content analysis, the first step is to reduce data using a perspective or conceptual framework (Catanzaro, 1988, Downe-Wamboldt, 1992). In Study I, “accessibility problems” was the focus of the data analysis. In Study III, the concept usability defined by Iwarsson and Ståhl (2003) formed the basis for the analysis. First, transcribed interviews were read several times to obtain a sense of the whole. After that, units comprising word or phrases relevant to the study were extracted and each unit was given a code. This process was done independently by the two authors. The codes that emerged were inductively generated from the data reflecting patterns that related to the perspective of the two studies. Similar codes were then placed into a category. After this, both authors compared codes and categories and agreed on the content of the categories after some discussion that resulted in minor adjustments. The categories were then reviewed and deemed significant and meaningful according to Catanzaro’s (1988) criteria for categories within content analysis. These criteria intend for the data placed in the categories to fit together in a meaningful way and for the differences among categories to be clear. This review was done by both authors and is an important part of the analysis, since a qualitative researcher may erroneously deny or attribute significance to particular data (Catanzaro, 1988). After this, a sample of the original interview text was tested against the categories that had emerged in the analysis.

PhenomenographyPhenomenography was originally developed by a research group in the Department of Education at the University of Gothenburg in the early 1970s. The word phenomenography first appears in the work of Marton (1981).

Phenomenography rests on a non-dualistic ontology, i.e., on the assumption that the only world that we can communicate about is the world as experienced. The epistemological assumption is that people differ on how they experience the world, but these differences can be described and understood by others (Sjöström & Dahlgren, 2002). Phenomenography, as a research approach, is designed to answer questions how people make sense of their experiences with the aim of discovering the structural framework within which various categories of understanding exist. These structural frameworks or categories of descriptions are useful in understanding other people’s understanding (Marton, 1994). The emphasis is on how things appear to people in their world, the way in which people explain to themselves and others what goes on around them, and how these explanations change (Barnard, McCosker & Gerber, 1999).

With phenomenographic data analysis, the intention is to identify the meaning content of perceptions and to present it in descriptive categories (Barnard,

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Methods___________________________________________________________________________

McCosker & Gerber, 1999). The transcripts of the interviews in Study IV were read through several times in order to get a sense of the whole. After this, the interviews were analyzed for relevant statements that contained perceptions of how the parents thought their child was influenced by playground designs. The analysis focused on comparing the statements to find similarities and differences. Perceptions that described different aspects of the same issue were then grouped together into patterns. These patterns emerged into four descriptive categories. Throughout the data analysis, the statements and perceptions were compared to the whole interview. The co-author’s assignment was to classify each statement from the interviews into one of the eleven perceptions and then assign the perceptions to one of the four descriptive categories to verify the extent to which the categories were consistent with the first author’s interpretation of the interviews.

Descriptive statisticsDescriptive statistics were used to analyse the data in Study II. Results from the questionnaire were interpreted by a frequency count to show the distribution of answers to each question. Variables in the questionnaire were foremost on a nominal level with only a few on an ordinal level. However, the results were presented by showing frequency distribution with numerical values and in percentages of the total.

Ethical considerations The ethical committee of Umeå University, in Sweden approved Studies III and IV (Dnr 06-002M). In research dealing with subjects under the age of 15, there is a problem regarding informed consent since these participants can lack autonomy and thereby have difficulties deciding if they want to participate or not. Therefore, informed consent was obtained from both parents and children in Studies I and III. In these studies both verbal and written information regarding the study were given before being asked to participate. In Study I, the creators of playgrounds were given verbal information regarding the study before they were asked to participate. In all the information, it was made clear that participation was voluntary and that participants were free to withdraw from the study at any time without giving a reason. Confidentiality was guaranteed the participants in these studies, and the studies were written in such a way as to ensure that the participants remain anonymous for the readers. The information to the children in the studies was presented in both a written and spoken form in a manner appropriate to the children’s age. Confidentiality were also explained in a way that the children would understand. However, children might not always understand the information given, therefore it is important to bear in mind that the foreseeable benefits of the research can be considered to outweigh any discomfort the children may have experienced. It is also important that the

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Methods___________________________________________________________________________

researcher tries to see when the child does not wish to participate. In this thesis, all these aspects have been adhered to. For example, when noticing that a child did not wish to expand on a question, further questions were not asked on the subject.

In Study II the letter that followed with the questionnaire explained the study and that participating was voluntary. Consent to participate was considered given when the questionnaires were returned.

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Summary of results ___________________________________________________________________________

SUMMARY OF RESULTS

Study I

Attitudes of key persons to accessibility problems in playgrounds for children with restricted mobility: A study in a medium-sized municipality in northern Sweden.The results in this study showed that the persons involved in creating playgrounds in this municipality described a fragmented organization and shortcomings in the procedures for building playgrounds. These shortcomings consisted of poor coordination, communication, and unclear or few directives. For example, when building a playground near the county hospital, a special slide for children with disabilities was ordered by the landscape architect, but no instruction had been given to the builder regarding the stairs leading to the slide (Fig 1-2).

Figure 1: The special slide Figure 2: Stairs to the slide

Furthermore, it was found that neither organizations for people with disabilities nor the municipality’s Committee for the Handicapped were consulted before planning or building playgrounds. The results of the study also indicate that the playground creators possessed insufficient knowledge on how to design accessible playgrounds. At the same time, the issue of accessibility came as a surprise to some of the persons planning and building playgrounds and some of the interviewees asked for more training and competence in the field. The financial problems also governed the design and building of playgrounds. Equipment adapted for children with disabilities were expensive, but so was consulting other professional groups on practical issues. The results showed that there had been no discussion about accessibility among the persons planning and building playgrounds in this municipality. The issue that a child with restricted

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mobility should be able to access playgrounds was also not discussed. And according to the playground creators, nobody requested that the playgrounds be accessible.

The children with restricted mobility in the study expressed that playgrounds were not a place for them. On some playgrounds they could not even enter and if they could, few if any play equipments were accessible to them. The results of the study also showed that adult support was a prerequisite for children with restricted mobility to play in the playgrounds. These adults had to help the children, lifting and carrying them to the play equipment. For example; paved paths usually only led through the playground or to the park benches from where parents or assistants had to carry the child to the swing (Fig 3). The adults described it as both physically and psychologically trying, when they could no longer lift and carry the child, and had to refuse the child the opportunity to play in playgrounds.

Figure 3. Paved path leading to the park benches (far right-hand corner).

Study II

Are playgrounds in Norrland (northern Sweden) accessible to children with restricted mobility?The results in this study showed that, in the 41 municipalities (that answered the questionnaire), only 2 of the 2,266 playgrounds were built to be accessible for children with restricted mobility. The results also showed that, of the 2,266 playgrounds, 46 had at least one playground equipment that could be accessed by a child with restricted mobility, making it a partly accessible playground. Of the 41 municipalities, six reported that there was no playground in the whole

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municipality where a child with restricted mobility could use any equipment on any of their playgrounds. The primary reasons why the children could not enter the playground or use the equipment were that the ground cover was either sand or gravel and had half-buried logs, or the playgrounds had enclosures with narrow openings (Fig 4). According to the respondents, the reason why the playgrounds looked this way and were inaccessible was that accessibility was something they had never thought about or discussed. The municipalities that had discussed the issue of accessibility claimed that they lacked knowledge and/or financial means to build accessible playgrounds. However, results showed that the 5 municipalities that had discussed the issue of accessibility and been in contact with organizations for persons with disabilities, also had 31 of the partly accessible playgrounds and the two completely accessible playgrounds.

Figure 4: Sand, half- buried logs and a narrow openingat the entrance to the playground.

Study III

Usability of playgrounds for children with different abilities. The children in this study described many similar experiences of activities that took place on the playground despite ability differences. The intensity and frequency in using the playground differed among the children depending on their abilities and playground accessibility. However, all the children viewed the playground as a place that they know very well and that they would miss it if it was removed. The playground was also viewed as a place for private

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conversation away from adults, but the children with disabilities expressed this view as a wish or as something that happened infrequently. The performance of some sort of challenge was viewed similarly by all the children, but the kind of challenge they described varied depending on each child’s abilities. Play equipment that had a recognizable design and encouraged role-playing was also similarly experienced and liked by all the children.

The results also indicated dissimilar experiences as a consequence of playgrounds, usability. The children without disabilities experienced the playground as a meeting place, a place were one never played alone, while the children with disabilities seldom played with friends. The children without disabilities described that their play activities in the playground had names and that the activities usually involved other children. On the other hand, the children with disabilities performed activities that had no names, mostly by themselves. For example, the slide was simply something you climbed and went down on or the swing was simply something you sat on. The design of the playground equipment hindered many of the children with disabilities to partake in play activities, something that the children without disabilities never mentioned (Fig 5).

Figure 5. Stairs, sand and curbstones makes this play equipment like “Fort Knox” for a child in a wheelchair.

Study IV

How playground designs influence children with disabilities - parental perceptions.According to parents’ perception, the results from this study show that

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playground designs negatively influence children with disabilities. The parents perceive that their children missed opportunities to play and participate in play with other children on the playground. The parents also perceived their children to be dependent on support from adults and thereby lacked opportunities to be or feel independent if they wanted to play on the playground. Since their children could not perform activities in the same way or manner as the other children, the parents perceived that playgrounds made their children feel different and consequently avoid participating in playground activities. The results also indicated that playground was an environment avoided by both children and parents, and that the negative influence playgrounds had on their children was a problem society should do something about.

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Methodological considerations ___________________________________________________________________________

METHODOLOGICAL CONSIDERATIONSFor each study, different strategies were used to strengthen the validity or trustworthiness of the study. The concept trustworthiness refers to the extent to which the findings are authentic reflections on the personal or lived experiences of the phenomenon under study (Barbour, 1998). Trustworthiness is discussed in relation to Lincoln and Guba’s (1985) concepts of Credibility, Dependability, Transferability and Confirmability and in accordance with Graneheim and Lundman’s (2004) aspects of trustworthiness in relation to qualitative content analysis.

To strengthen the credibility of both quantitative and qualitative studies, pre-understanding and bias have to be dealt with throughout the whole process of inquiry (Nyström & Dahlberg, 2001). A person’s pre-understanding may facilitate as well as constrain understanding of the phenomenon being studied. According to Gadamer (1975) the best way to deal with pre-understanding is openness, having an open attitude when confronted with new experiences enable us to see the otherness of the phenomenon that does not already exist in our pre-understanding. Openness also means to be aware of one’s own history and possible bias due to one’s pre-understanding. Since the research issue was new to me (the researcher) in Studies I and II, keeping openness to the phenomenon was not a problem. In Studies III and IV, I tried to keep an open mind throughout the whole process by listening to the participants’ experiences and asking them to describe their experiences in detail during the interviews. During the analysis I also tried to keep openness to the data by reflecting on my own pre-understanding on the subject. However I believe that my pre-understanding facilitated the interviews, especially in Study IV where some questions asked were never previously reflected on by the parents themselves. This strengthened the interviews by making them more comprehensive.

An audit trail, or the detailed description of the research process, was written in the studies. The concept of an audit trail was developed by Lincoln and Guba (1985) in relation to the concept of confirmability. This strategy implies an external auditor that follows the progression of the study in order to try and understand how and why certain decisions were made. In these studies, there was no external auditor present, but the research process is presented in such a way that others should be able to judge the study’s trustworthiness.

Interviews were conducted in Studies I, III and IV. Selecting the most appropriate data collection method in order to answer the research question is important when establishing credibility (Graneheim & Lundman, 2004). In order to capture the participants’ descriptions of the phenomenon being studied, interviews were perceived to be the most appropriate data collection method.

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Nevertheless, there is always the possibility of leading questions, as discussed by Kvale (1996), especially when it comes to interviewing children. In Study III only children were interviewed. One strategy to avoid leading questions was the use of an interview guide. The questions were broad with an outline of different topics. Thereafter, the children were asked follow-up questions based on their descriptions. Since some of these children had very little experience of playgrounds, a deviation from the interview guide was employed by posing some of the questions in a more visual manner like, “ if you could have been on the playground…” and “what do you wish for…”. This deviation from the interview guide might in some way have affected the credibility of the study. Another aspect regarding credibility according to Graneheim and Lundman (2004), is how well the different categories in the studies cover all the data collected. In Study III, some data were omitted, since it was of a more private character, and did not pertain to the research issue. That the participants were only interviewed once can be considered a limitation in study I, III and IV since a second interview might have added more information on the issue. However, the fact that the different studies in the thesis and previous research all point in the same direction might be considered a way to judge trustworthiness of the studies.

Providing demographic information on the groups in Studies I, III and IV, was one way to address transferability of the studies. Since the aim of these studies was not to make generalizations about the findings the participants were instead described allowing the reader to assess how transferable the findings are (Graneheim & Lundman, 2004; Lincoln & Guba, 1985). In Studies III and IV, draft copies have been discussed with colleagues familiar with qualitative research in order to discuss alternative explanations and possible bias with the intention of strengthening credibility. However, these colleagues were not familiar with the research issue and could therefore judge only about the logic and clarity of the research but not alternative explanations. Studies I and II were also discussed with peers at a licentiate thesis seminar. Presenting quotations in Studies I, III and IV, shows that the findings are grounded in data. The quotations will also enable the reader to ascertain whether inferences based on data are logical. According to Lincoln and Guba (1985), this is another strategy for strengthening a study’s confirmability and it is also a way of strengthening a study’s credibility and transferability (Graneheim & Lundman, 2004).

Validity is a way to describe the extent to which a measure accurately represents the concept it claims to measure. In study II the internal validity was assessed using content validity which refers to how adequately the sampling of questions reflect the aim of the assessment, and is one way to measure validity (Polit & Beck, 2004). Content validity is particularly important in measuring if the study is designed to ascertain respondents’ knowledge within a field (Eby, 1993). The

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questionnaire used in Study II was also assessed by content validity. The designing of the questionnaire was conceptualized from an exhaustive literature review and from the findings of Study I. The questionnaire was sent to all the municipalities in Norrland and the sample consisted of almost 80% of the total population. Therefore, it is reasonable to believe that the findings can be generalized to all municipalities in Sweden. It is, however possible that municipality in the south of Sweden with shorter winters would focus more on making playgrounds accessible since the playground season is longer. However, in relation to other studies (Christensen & Morgan, 2003; RBU, 2006; Stout, 1988; Thompson, Hudson & Bowers, 2002), the findings in this study seem to apply to other parts of Sweden and even to other countries in the western hemisphere. This could be one way to measure the study’s external validity.

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General discussion ___________________________________________________________________________

GENERAL DISCUSSION The overarching aim of this thesis was to identify and explore aspects of playground accessibility and usability for children with disabilities. In Studies I and II the findings revealed the lack of accessible playgrounds and some of the reasons why playgrounds are inaccessible. In Study III, the findings indicated that playgrounds are an important environment for all children regardless of ability, and that a playground is seen foremost as a place that can offer social interaction with peers. The findings in Study IV was that parents to children with disabilities perceived that playground designs influenced their children by being an environment that hindered independence, play, and participation with peers in play activities. The main finding of this thesis is that playgrounds in Sweden are not an accessible environment and therefore not usable to many children with disabilities. By not being accessible and usable the playground affects children with disabilities in several negative ways that can cause play deprivation, dependency, and stigmatization.

Playgrounds should enable and enhance social interaction Why do we bother to build playgrounds? Is it so, that we still build playgrounds so that children can act out their physical energy or do we as adults have another reason for building them today? Perhaps it is once again time to think about why we have playgrounds. Is it once again to keep our children off the streets, or perhaps, is it to give them an alternative or compliment to computer games or a compliment to organized play by providing them a place for free play activities?

A main finding in studies I, III-IV was that, due to the lack of accessibility to playgrounds, participating in play was difficult or impossible for many of the children with disabilities. The findings in Study III showed that the most important function of the playground was to offer social interaction with peers and that this interaction was something described by all the children regardless of ability. Several studies (Blatchford, 1998; Bixler, Floyd & Hammit, 2002; Frost, 1997; Sutteby & Frost, 2002; Zinger, 2002) confirm that, for children from 7 to 12 years of age, social interaction with peers in play on playgrounds is important and has a high priority. It is estimated that children of that age spend from 20 to 25% of their school day in recess and that this time is spent mostly on the playground at school. Within developmental psychology research, the term “playground culture” is well established and according to Sutton-Smith (1990): “there is a culture of school playgrounds play, just as there is a culture of schooling…Further, the school playground children culture is apparently one of the most important as far as the children are concerned” (p5). According to other studies within developmental psychology (Andersson-Butcher, Newsome,& Nay, 2003; Barbour, 1999; Pellegrini & Blatchford, 2000; Sluckin, 1981)

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“playground culture” is not easily recognized by adults but this culture is nevertheless very important for children since it is in this culture friendships are formed. These friendships in turn support children in adjusting to school and improve social and communicative skills. According to Blatchford (1998), children that have formed friendships during school recess have a tendency to perform better at school. Play on playgrounds can also help in the acquisition of many subtle social skills essential to later life and in the preparation for adulthood (Sutton-Smith, 1990). Studies I and III show that children with disabilities rarely play on playgrounds because of the physical barriers in the environment. The children without disabilities (Study III) describe their play on the playground as something with unique meaning and purpose, they gave their play names, like shark or monster, they never played alone and they rarely played with an adult. For the children with disabilities, it was the opposite; their play was described by some as hard work, had no names, was seldom played with peers, and required adult support. The question is what consequences these differences, due in part to inaccessible playgrounds, might have for children with disabilities. One consequence is that children with disabilities do not describe play as an occupation, in other words something with unique meaning and purpose, the way occupation is defined in this thesis. Play on playgrounds was described by the children with disabilities more as activities that were goal directed and relevant activities to be performed on a playground. However, their experiences of the activities seemed to lack importance and a special meaning. The challenge for occupational therapists and other professionals is therefore to enable children with disabilities to be able to experience play as something with unique meaning. Another consequence, for the children with disabilities, is the limited participation in play, which in turn can result in poor social skills, limited intrinsic motivation, lack of drive, decreased concentration, and more solitary play or play with adults, consequences that in turn could affects the children’s identity and health (Brown & Gordon, 1987; Lightfoot, Wright & Sloper, 1999; Mulderij, 1996; Nabors & Baldawi, 1997; Tamm & Skär, 2000).

With increased attention on participation by the WHO (2001) it is important for occupational therapists to understand participation and what can enable or hinder it. As Law (2002) stated in her Distinguished Scholar Lecture, “participation is the raison d’être of occupational therapy; it is what we are all about; it is our unique contribution to society” (p.640). Research has shown that environmental factors have a major affect on hindering participation for people with disabilities. One of these factors is the lack of including people with disabilities in planning different environments, according to several disability studies (Barnes, Mercer & Shakespeare, 1999; Hahn, 1988; Oliver, 1996). Even though the ICF focus is more on participation and environment, one aspect that the ICF have been criticized for is the exclusion of subjective experiences regarding participation (Hemmingsson & Jonsson, 2005). This important aspect

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of participation might be missed if only objective measurements and evaluations are used. It is therefore important that research and assessments within occupational therapy and other professions take in the subjective experience of participation. This aspect is of importance for the clients occupational therapists meet and therefore it felt essential to include the children’s perspective on playgrounds in this thesis. The findings in Studies I and III show that the children’s subjective experience of playgrounds is that it is an environment that offers similar experiences regardless of ability, like a place to meet friends and challenges, and that the children all wished for similar things on the playground. That the children’s subjective experiences of playgrounds is to some extent similar should make it even more important to eliminate the experiences that are dissimilar that are caused by removable obstacles in the physical environment.

In Study III and IV, universal design is suggested as a way to create playgrounds that would enable participation not only for children with disabilities but for all children. For occupational therapists, this would entail advocating for the application of universal designs principals in the planning and building of playgrounds in the community, playgrounds that would enable participation in activities for all children. It is also important that occupational therapists increase their knowledge about the activities that take place in a playground and about the users’ subjective experience of this environment so that the advocating for playground design could enable all children to experience play as an occupation.

Occupational therapists already have a collection of knowledge needed to build public places using the universal design concept like understanding of human functioning, occupational performance, person-environment interaction and assistive technologies (Ringaert, 2003). However, besides more knowledge regarding different user groups’ subjective experience of different activities more knowledge regarding standards, guidelines and architectural drawings are still needed. With this competence, occupational therapists could focus more on changing different environments in the community and thereby enabling participation in play on a playground for children with disabilities, for example.

Playgrounds can cause play deprivation, dependency, and stigmatizationThe results from Study III, indicate that children without disabilities spend a lot of time playing on playgrounds foremost during school recess. Nevertheless, the results in this thesis indicate that children with disabilities are deprived to a great extent of playing on playgrounds due to the playgrounds’ lack of accessibility. Within occupational therapy research, there is evidence that both lack of participation and occupational deprivation can lead to poor health and poor well-being (Missuna & Pollock, 1991; Whiteford, 2000; Wilcock, 1998).

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The findings in this thesis point to that playgrounds cause, to some extent, play deprivation, and, as mentioned earlier, lack of participation. According to several studies (Keating & Hertzman, 1999; Missuna and Pollock 1991; Sandler, 2001; Werner, 1990; Zeitland & Williamsson, 1990), play deprivation can lead to cognitive, social, and behavioral delays resulting in increased dependency, decreased motivation, lack of assertiveness, and low self-esteem. Due to play deprivation, children with disabilities can also become less skilled at solving mental problems and interacting with peers. In other words, lack of accessibility and poor usability of a playground can deprive children with disabilities the opportunity to engage in play. In Study IV, decreased motivation, lack of assertiveness and low self-esteem could be interpreted from the findings. Increased dependency on adults was clearly found in both Studies I and IV.

Independence in most western countries is something of high value. For most parents, fostering independent children is a primary goal, in our culture. Always having an adult present and being dependent on someone when playing at the playground, could be to go against cultural practice and as the children in Study I and III described they also expressed wishes to be able to be on the playground without an adult. This might be one reason why the parents in Study IV also avoided playgrounds. Children from 7 to 12 years of age are disinterested in spending time with adults, including their parents, and value the time spent with peers more (Case-Smith, 2005). Children need to feel a sense of accomplishment from doing things independently and, at the same time, connect with friends, which is important for children’s self-esteem (Heah, Case, McGuire & Law, 2007) Children also need to feel successful and independent and be with peers to experience enjoyment in performing an activity (Csikszentmihalyi, 1988). Therefore, the need to do things independently is something adults need to be able to recognize in children with disabilities. It is important for parents, occupational therapists and other adults around the child to identify what the child enjoys doing, can be successful at, and can do independently. In order to accomplish more play with friends and to minimize dependency on adults, one prerequisite is a well designed playground, with as little adult intervention as possible.

For children with disabilities, playgrounds are an environment where they feel different (Study IV). According to Goffman (1963), experiencing feelings of being different can foster a negative identity development. Results similar to Study IV were found by Segal, Mandich, Polatajko and Cook (2002b) that showed the consequences of feeling different is the same as being stigmatized, which in turn can result in being excluded from participation in activities. In order to avoid being stigmatized, children with disabilities often develop “stigma management techniques” which means avoiding certain environments and situations. This in turn can result in even more limited participation. Play on

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playgrounds could then, be a place for avoidance, resulting in even less opportunities for participation in play on playgrounds, a sort of catch-22. The question of whether building more accessible and usable playgrounds would prevent stigmatization or not, is not answered in this thesis but would be of interest for further research. However, according to several studies (Barbour, 1999; Goltsman, 2001; Ringaert, 2002), playgrounds that accommodate and encourage a range of play behaviors with focus on various abilities contributes positively to social acceptance and status among children. Another aspect of this is that play environments that are stimulating and supportive can enable children to feel successful in play situations which in turn can increase their self-esteem (Letts, Rigby & Stewart, 2003). Realizing that many of the children with disabilities have the capacity and ability to partake in many activities that take place on a playground if the physical environment was different, makes the problem of inaccessible playgrounds even more serious.

Lack of awareness of children’s rights Considering the negative ways playgrounds influences children with disabilities, it is time to start looking at the opportunities a well designed playground can offer. In the findings from Study III, all the children asked for play equipment with recognizable designs, like houses and boats, and play material that are movable. In several studies, these wishes for ‘real things’ that encourages fantasy and role-playing on the playground has also been found (Barbour, 1999; Edwards, 2000; Mårtensson, 2004). Since studies have shown that a wish for ‘real things’ in playgrounds exists and that play is important, one can only raise the same question Wilhjelm, (2002) did about if architects and other persons designing and planning playgrounds, if they update their knowledge base when planning for children and their environment. Perhaps, the role of occupational therapists could be to encourage other key parties in the community to enhance play environments on a societal level in order to support play for all children.

The findings from Studies I and II indicated that persons in charge of creating playgrounds were not aware of how inaccessible playgrounds are. The findings show that it was not the budget or a lack of knowledge on building more accessible playgrounds, which was behind the small number of accessible playgrounds, but a more general lack of awareness in terms of accessibility. The question regarding accessible playgrounds does not seem to have been discussed much in Sweden. The result of this lack of awareness was evident since, according to Study II, only 2 % of the playgrounds in northern Sweden were partly accessible. Being unaware of playgrounds’ lack of accessibility must also mean an unawareness of the legislation that governs playgrounds that clearly states that public spaces should be accessible and usable and the amendment to this legislation with demands on the removal of easily eliminated obstacles on playgrounds. This amendment is from 2003 and yet, only 1.4 % of Sweden’s

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playgrounds are accessible in 2006. However, since the amendment does not have to be implemented until 2010, the municipalities in Sweden still have some time to comply with these laws and legislations.

There are also some conventions that Sweden has signed that should support accessible playgrounds. The Convention on the Rights of the Child (United Nations, 1993) does not state that playgrounds should be accessible. However it does state that the special needs of children with disabilities should be recognized and that children with disabilities should have access to recreational opportunities, individual development, and to the fullest possible social integration. The fact that playgrounds are an important environment for all children, but does not support play and social integration for children with disabilities, reveals a shortcoming in adhering to the convention’s principle. Another article of the convention mentions that a child must be protected from all forms of discrimination. In Study II, it is argued that being excluded from a section of society that is important for children, like playgrounds, is a way of discriminating against children with disabilities. If playgrounds that are not accessible are to be considered discriminatory environments it can be argued that the Convention of the Right of Persons with Disabilities (United Nations, 2006) is also being violated. Article 30 of this convention states that the equal access of children with disabilities with other children to participation in play activities should be ensured. Another United Nations convention is the Standard Rules on the Equalization of Opportunities for Persons with Disabilities (United Nations, 1989), which states that persons with disabilities should have equal opportunities for recreation and sport. This convention also states that persons with disabilities should be consulted before developing services for persons with disabilities. Findings from Studies I and II showed that persons with disabilities, especially children, are rarely involved in planning playgrounds.

Focus on the environment to enable play According to resent research, occupational therapists working with children are focusing mainly on body structures and body function, with relatively little focus on activities and participation levels using the terminology of the ICF (Barnes, Beck, Vogel, Grice & Murphy, 2003; Burtner, McMain & Crowe, 2002; Howard, 2002; Rodger, Brown & Brown, 2005). The focus of this thesis has been on the physical environment, but for occupational therapy, enable occupational performance is of prime importance. Changing the physical environment of playgrounds can be a powerful way to improve occupational performance for children with disabilities. In order to change the environment, occupational therapists need to work on a societal level by participating in the design of public spaces or advocating for accessibility and usability in the community in order to enable play for children with disabilities. Universal design is a field where occupational therapists can contribute with the

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professions knowledge on human functioning, disability, and the person-environment interaction. This is also in line with the reasoning within disability studies that rehabilitation should focus more on societal attitudes and actions (Hahn, 1988). Here is an opportunity for the field of occupational therapy to expand, and give more consideration to disability studies and universal design theories, and start to contribute more on a societal level. However, as argued by Kielhofner (2005) occupational therapy cannot leave the individual level and work only on a societal level. Therefore, it is also important that occupational therapist work with the child, the child’s family, and the school to enable play.

For occupational therapists, it is important to work with family education, to help the parents understand the importance of play in a child’s development. It is also important that adults around the child facilitate reciprocal interactions between children with and without disabilities that promote friendship and supportive peer networks. In situations where social “stigma” is an issue, explaining a child’s disability for the other children is one strategy occupational therapists can use (Case-Smith, 2005). Another way is recognizing the child’s need to feel a sense of accomplishment from doing things independently and encouraging persons around the child to provide opportunities for this (Heah, Case, McGuire & Law, 2007). Occupational therapist could also work with the child by facilitating the acquisition of skills needed for different play activities on the playground and to provide opportunities for the child to try their skills in the actual setting. To practice using the playground at school and in the neighborhood might give children with disabilities the courage to play there and thereby improve their chances of participating in activities with other children. It is therefore important that all playgrounds are made accessible and usable since both the school and neighborhood playground might be of importance for children.

In conclusion, much work remains in improving playground accessibility and usability. Nevertheless, removing physical barriers does not necessarily lead to social inclusion or participation in play. Since playgrounds are according to the children in Study III also a social meeting place, accessibility and usability should be accompanied by full social access as well. Occupational therapists need to learn more about play on playgrounds in order to enable play for children with different abilities. The results presented in this thesis, points to a problem in our society that limits activities for a number of children, and poses a threat to these children’s health and development. That purposeful and meaningful everyday occupation, like play, is considered health promoting, is a corner stone within occupational therapy theory (AOTA, 2002). Therefore, the efforts of occupational therapists working to promote accessibility and usability in playgrounds can be seen as being both health promoting and preventive.

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Future research One must be aware that today’s laws and legislations have their emphasis on physical access to playgrounds. However, if social inclusion is not in focus, a playground that is only physically accessible may actually emphasize a child’s disability more by placing the child in a situation where their inability to participate is significantly more noticeable. Constructing a playground where the main emphasis is on social inclusion and all accessibility issues are solved is truly the playground of the future. Therefore, more research is needed to investigate what kind of playground equipment can support and encourage social inclusion. More research is also needed to find out where play activities takes place on playgrounds and how these places can be built so that children with disabilities can use them independently and on equal terms as children without disabilities. Accessible playgrounds usually focus on children using wheelchairs. What is needed is more research on how to enable play on playgrounds for children of all abilities.

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Summary in Swedish ___________________________________________________________________________

SAMMANFATTNING (IN SWEDISH)

Lekplatsers tillgänglighet och användbarhet för barn med funktionsnedsättningar. Erfarenheter från barn, föräldrar och professionella.Lekplatser är viktiga miljöer där barn leker under sin barndom. Lekplatser är speciellt designade för att barn skall kunna utföra många olika aktiviteter och samspela med varandra. På lekplatser utvecklas barns medvetenhet om miljön och på lekplatser lär sig barn sociala regler och värderingar. Lek på lekplatser kan vara en viktig del av ett barns utveckling, fysiskt, kognitivt, emotionellt och socialt. Lek tillåter barn att experimentera med olika saker, att fatta beslut, att förstå orsak -verkan och att lära känna sin egen styrka och sina egna begränsningar. Leken uppmuntrar till kreativitet och inlärning och utvecklar barnets sociala färdigheter. Barn med funktionsnedsättningar kan möta många problem i den fysiska miljön, därför är utformningen av fysiska miljöer viktig. Bristande tillgänglighet i den fysiska miljön kan leda till stress och frustration, hindra den motoriska utvecklingen och störa den sociala utvecklingen. Det kan röra sig om rent fysiska barriärer, där trånga och otillgängliga miljöer skapar stress och aggressivt beteende hos barn. Men det kan även röra sig om sådana hinder som att barnen med olika funktionsnedsättningar sällan är ensamma utan är oftast i sällskap med vuxna vilka ”övervakar” deras situation och därigenom ”stör” den normala leken och andra aktiviteter på lekplatsen. Att vuxna är med beror ofta på brister i den fysiska miljön men den miljö som de vuxna ofta ”stör” är den sociala miljön. Att öka kunskapen om hur tillgängliga lekplatser är för barn med funktionsnedsättningar och hur användbara de upplevs vara för barn är en viktig aspekt för hur denna miljö skall utformas för att möta målen i den nationella handlingsplanen för handikappolitiken om ett ”Sverige tillgängligt för alla år 2010”. Det övergripande syftet med denna avhandling var därför att identifiera och undersöka olika aspekter kring lekplatsers tillgänglighet och användbarhet för barn med funktionsnedsättningar.

Avhandlingen består av fyra delstudier där de två första (I, II) primärt svarar på det övergripande syftet att identifiera lekplatsers tillgänglighet. De två andra studierna (III, IV) svarar främst mot syftet om att undersöka olika aspekter kring lekplatsers tillgänglighet och användbarhet för barn med funktionsnedsättningar.

Syftet med studie I var att belysa vad två grupper av nyckelpersoner – ”skapare av lekplatser” och ”nyttjare av lekplatser” - anser om tillgänglighet på lekplatser. En semistrukturerad intervju användes för att samla in nyckelpersonernas erfa-renheter och uppfattningar av att skapa respektive nyttja lekplatser. Denna explorativa intervju användes för att belysa ett relativt outforskat område och finna intressanta frågor som kunde studeras vidare. Exempel på frågor till dem

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som skapar lekplatser var: Har tillgänglighetsaspekten diskuterats vid nybyggnad eller renovering av kommunens lekplatser? Har handikapporga-nisationerna varit delaktiga vid planeringen av nybyggnad eller renovering av kommunens lekplatser? Exempel på de frågor som ställdes till dem som nyttjar lekplatser var: Hur har du upplevt tillgängligheten till lekplatser? Hur önskar du att lekplatser skulle vara utformade? Intervjuerna med de nyckelpersoner som skapar lekplatser genomfördes på respektive persons arbetsplats. Intervjuerna med de nyckelpersoner som nyttjar lekplatser, genomfördes för barnens och förälderns del i deras hem, assistenterna intervjuades i skolorna.

Studiens resultat visade att handikappanpassade lekplatser var något som man inte hade tänkt på från kommunens sida. Bristande kunskap och bristande ekonomi ansågs som bidragande orsaker till varför tillgängligheten till lekplatserna var så begränsad. Vidare visade resultatet att den bristande tillgängligheten verkade ha varit en överraskning för dem som skapar dessa miljöer, eftersom de inte hade tänkt på saken innan frågan ställdes. De barn med rörelsehinder och de vuxna i deras sällskap som nyttjade lekplatserna upplevde att dessa inte var tillgängliga miljöer för dem. Barnen beskrev att deras kompisar ofta var på lekplatsen men att de själva inte kunde delta i deras lekar. För att kunna vara på lekplatsen behövdes assistans från någon vuxen. Detta beskrevs av assistenterna som fysiskt tungt att behöva bära barnet till olika lekredskap men även psykologiskt jobbigt att behöva neka barnen att vara på lekplatsen när de inte orkade bära barnet till de olika lekredskapen längre.

Syftet med studie II var att beskriva hur tillgängliga Norrlands lekplatser är för barn med rörelsehinder. Undersökningen utfördes som en deskriptiv enkätstudie, som valdes för att kunna göra en totalundersökning, det vill säga, undersöka hur det totalt förhöll sig med lekplatserna i Norrland. Enkäten konstruerades utifrån resultaten i studie I och kom att bestå av 8 slutna och 5 öppna frågor. Frågorna i enkäten var adresserade till den i kommunen som ansvarade för kommunens lekplatser. Exempel på frågor i enkäten var: Hur många lekplatser finns i er kommun? Hur många är handikappanpassade? På vilket sätt är de anpassade? Kan ett barn i rullstol själv; -komma in på lekplatsen, - fram till lekredskapen, - använda lekredskapen. Vilka yrkesgrupper deltar vid planeringen av nya lekplatser? Har frågan om anpassade lekplatser varit aktuell hos er? Frågorna i enkäten var retrospektiva, dvs. vad som hade gjorts eller inte gjorts för att anpassa lekplatser i de olika kommunerna. Den deskriptiva enkätstudien utfördes för att få en bild av lekplatsernas anpassning vid en viss tidpunkt och i ett visst geografiskt område. Resultaten visade att endast två lekplatser av sammanlagt 2266 lekplatser, i de 41 kommuner som besvarade enkäten, var helt anpassade för barn med rörelsehinder. Av dessa 2266 lekplatser uppgav respondenterna att 46 lekplatser var delvis anpassade, medan de återstående 2218 inte var anpassade alls. Vidare framkom i resultaten att den huvudsakliga

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orsaken till varför så få lekplatser var anpassade var att ingen hade tänkt på saken.

Syftet med studie III var att beskriva hur barn med olika förmågor upplevde lekplatsers användbarhet. I studien deltog sammanlagt 20 barn i åldrarna 7 till 12 år, fem barn med rörelsehinder, fem barn med grav synskada, fem barn med måttlig utvecklingsstörning och fem barn utan diagnos. En semistrukturerad intervju användes för att samla in barnens erfarenheter av lekplatsers användbarhet. Intervjufrågorna syftade till att fånga barnens tankar om och erfarenheter av lekplatser. Barnen blev ombedda att berätta utifrån den övergripande frågan "vad kommer du att tänka på när du hör ordet lekplats" samt följdfrågor utifrån barnens berättelse samt frågor om utformning och erfarenheter av att använda lekplatser. En kvalitativ innehållsanalys användes för analys av data. Resultaten av analysen visade att oberoende av förmåga så upplevde barnen många liknande aktiviteter på lekplatsen, i varierande form och omfattning. Alla barn beskrev att de önskade lekstugor, bilar, båtar eller andra lekredskap med en enkel utformning som inspirerar till låtsas- eller rollek. För barnen med funktionsnedsättningar utgjorde däremot lekplatsens design ett stort hinder för deras möjlighet att leka med andra barn. De var ofta beroende av någon vuxen vilket begränsade deras kontakt med andra barn. De upplevde även att det var svårt att leka på lekplatsen främst på grund av den fysiska miljöns utformning. Resultaten diskuteras utifrån hur detta påverkar delaktigheten för barn med funktionsnedsättningar. Vidare diskuteras att detta problem är på samhällsnivå där arbetsterapeuten med sin kunskap har mycket att tillföra vid planering av denna miljö.

Syftet med studie IV var att beskriva hur föräldrar till barn med funktionsnedsättningar uppfattar att deras barn påverkas av lekplatsers utformning. I studien intervjuades 18 föräldrar till barn med olika funktionsnedsättningar, sex var föräldrar till barn med rörelsehinder, sex föräldrar till barn med grava synskador samt sex föräldrar till barn med måttlig utvecklingsstörning. De erhållna data analyserades utifrån fenomenografisk metod. Resultaten visade att föräldrarna uppfattade lekplatsens utformning som ett hinder för att deras barn skulle kunna leka självständigt där. Föräldrarna uppfattade även att lekplatsens utformning hindrade deras barn att umgås med andra barn. Lekplatser var även en miljö som fick barnen att känna sig annorlunda. Föräldrarna uttryckte även en ilska mot att samhället inte gjorde något åt problemet. Resultaten diskuteras utifrån hur bristande delaktighet kan påverka barn med funktionsnedsättning samt utifrån aktuell svensk lagstiftning om allmänna platsers tillgänglighet, och hur konceptet Universal Design är ett sätt att tänka kring lekplatsers utformning.

Sammanfattningsvis visar resultaten i denna avhandling att lekplatser brister i

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både tillgänglighet och användbarhet, vilket i sin tur resulterar i att begränsa barn med funktionsnedsättningars aktivitietsutförande i denna miljö. Lekplatsernas bristande tillgänglighet kan orsaka stigmatisering och bristande självständighet för barn med funktionsnedsättningar. Vidare framkom att det finns en bristande förståelse för detta problem trots att det finns lagstiftat att även lekplatser skall vara tillgängliga och användbara för personer med funktionsnedsättningar. Lekplatser är en social plats för barn, det är på lekplatser barn leker med sina kamrater, väntar på kamrater eller hittar nya kamrater. Den bristande tillgängligheten till och på lekplatser orsakar att barn med funktionsnedsättningar inte är delaktiga i denna sociala miljö. För att kunna förändra denna miljö kan arbetsterapeuter med sin kunskap om hur miljön och olika funktionsnedsättningar påverkar aktivitetsförmågan bidra till att skapa lekplatser tillgängliga och användbara för barn med olika funktionsnedsättningar.

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Acknowledgements ___________________________________________________________________________

ACKNOWLEDGMENTS

I would like to express my gratitude to everyone who assisted me in the work on this thesis. I am deeply indebted to all of you but I would like to express a special thank you to:

All my “informants” in the studies, all the children, parents and professionals who showed patience, motivation and willingness in providing me with information and experiences necessary for compiling this thesis.

Professor Jan Johansson, my main supervisor for professional advice during different stages of the process.

Assistant Professor Lisa Skär, my assistant supervisor and long-time friend, for excellent guidance through the second half of this thesis by generously sharing her knowledge, never-ending support and capability of giving constructive criticism.

Assistant Professor Maare Tamm, my first assistant supervisor, for choosing me to be her assistant a long time ago and thereby introducing me to the world of research. Thank you for sharing your knowledge with me.

My “home” Department of Health Science at Luleå University of Technology and the support and encouragement of many people there, and a special thankyou to Professor Karin Axelsson.

My colleagues at the Division of Health and Rehabilitation, for friendship and support, a special thank you to: Gunilla Isaksson, for being a good friend and always taking your time to listen to my thoughts and idea’s. For making me feel better when I doubted myself. Anneli Nyman, for taking your time reading and discussing different aspects of occupational therapy theories. Agnetha, Cecilia, Ann-Louice and Ulrica, for your genuine interest and stimulating discussions on the subject.

To all doctorial students at the Department of Health Science for valuable comments on the manuscript during seminars and to our great lunch meetings.

Assistant Professor Maria Larsson-Lund for valuable comments on the manuscript and for your encouragement.

48

Acknowledgements ___________________________________________________________________________

Last and most of all my family: to Kurt for your love, your belief in me and for never-ending support. To our children, Tim, Marina, Elina, Emil and Ewa and our grandchildren for keeping me in touch with reality and constantly reminding me that life is more than work.

To my relatives that have listened with interest and patience to my playground stories for years.

The studies in this thesis were financed by Luleå University of Technology and grants from “Save the Children” – Sweden, Norrbacka – Eugeniastiftelsen and the Swedish National Association for Disabled Children and Adolescents (RBU).

49

References________________________________________________________________________

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SCANDINAVIAN JOURNAL OF OCCUPATIONAL THERAPY 1999;6:166–173

Attitudes of Key Persons to Accessibility Problems in Playgrounds for Childrenwith Restricted Mobility: A Study in a Medium-sized Municipality in NorthernSweden

MARIA PRELLWITZ and MAARE TAMM

From the Boden Uni�ersity College of Health Sciences, Boden, Sweden

Prellwitz M, Tamm M. Attitudes of key persons to accessibility problems in playgrounds for children withrestricted mobility: a study in a medium-sized municipality in northern Sweden. Scand J Occup Ther 1999; 6:166–173.

Playgrounds are an important outdoor environment for children. Yet few playgrounds are designed to beaccessible to children with restricted mobility. In this study the child with restricted mobility is defined asone who is unable to move around without the aid of a wheelchair, walking-frame, walking-stick or otherwalking device. The purpose of the study was to explore the attitudes to accessibility problems inplaygrounds among two groups of key persons: ‘‘creators’’ and ‘‘users of playgrounds’’ in a medium-sizedmunicipality in northern Sweden. Eleven key persons (5 ‘‘creators of playgrounds’’ and 6 ‘‘users ofplaygrounds’’) were interviewed in a semi-structured interview. The interviews were analysed according tocontent analysis and could be coded under different themes. The results showed that those who createdplaygrounds had (i) a fragmented organization, (ii) insufficient knowledge of disabilities, (iii) poor economy,and (iv) attitudes as an obstacle. Interviews with the users of the playgrounds were coded under two themes(i) the playground is not for me (i.e. for children with restricted mobility) and (ii) assistance is a preconditionfor accessibility. The results were discussed in the light of how the inaccessibility of play environments canaffect the development of children with restricted mobility, and affect their possibilities of a life on a parwith that of other children. Key words : accessibility, children with restricted mobility, playgrounds.

INTRODUCTION

Play is an important part of children’s development,physically, cognitively, emotionally and socially. Playallows children to experiment with different things, tomake decisions, to understand cause–effect processes,and to recognize their own strengths and limitations.Playing encourages creativity and learning, and devel-ops children’s social skills [1, 2]. Playing also helpsthe child to cope with disappointment, anxiety andfear [3].

From the perspective of occupational therapy, playis considered to be the primary activity of the child.Play arises from the curiosity of a child learning howobjects, people and events function. This learningprocess is fundamental to children’s development,and a prerequisite for competence in occupationalroles later in life. [4]. A child with restricted mobilityhas fewer opportunities to experiment with objects inthe surrounding environment, which can lead to areduction in the child’s exchange of information withhis/her surroundings. The child then misses severalexperiences that other children without these prob-lems have. This, in turn, can lead to the child with-drawing from social situations and becoming moredependent on adults than is necessary. As a conse-quence of several factors in interplay, the child withrestricted mobility can acquire secondary psychologi-cal and social handicaps, such as poor self-esteem,isolation, marginalization, and so on. [5]. Research

studies show, for example, that children with re-stricted mobility perform fewer activities than otherchildren, they are more likely to play alone (or withan adult) than with their peers, and in many casesthis is because these children do not have access tothe same play environments that their peers frequent[6, 7].

Playgrounds are important environments wherechildren play during their childhood. Playgrounds arespecially designed for children, where they can per-form many different activities and interact with oneanother. In playgrounds, children have opportunitiesfor motor activities, running, swinging, climbing, andfor social activities, interacting with each other injoint activities. In playgrounds, children’s awarenessof their environment is developed, and it is usually inthe playground that children learn about socialnorms and values [3, 8].

How should playgrounds be constructed to corre-spond to the different needs of children? Researchshows [3, 9, 10] that there are three different types ofplaygrounds: (i) traditional, (ii) modern and (iii) ad-venture. Of these three types of playground, thetraditional and modern are the most common. Thetraditional playgrounds are often found close to aschool, a small park or blocks of flats. They accom-modate swings, slides, seesaws, sandpits, and climb-ing frames. This play equipment is often made ofmetal and iron chains (extremely insensitive to flesh

© 1999 Scandinavian University Press. ISSN 1103-8128

Accessibility problems in playgrounds 167

and blood) and is not especially aesthetically pleas-ing. Modern playgrounds in general contain the sameequipment as the traditional ones, but, instead, theyare built of wood, and have steps and suspensionbridges to create different levels connecting the differ-ent pieces of play equipment. Most play equipmentcan be used in more than one way. These play-grounds are constructed with a strong appreciationfor colour and form and there is an emphasis on theaesthetic aspect. Adventure playgrounds have noready-made play equipment, but here the childrencan build for themselves using wood and other mate-rial, and using their own imagination, sometimesunder the leadership of an employed play leader.

Traditional playgrounds are suitable for, and usedby, small children and children of preschool age.Modern playgrounds are used by both preschool andschoolchildren. Adventure playgrounds are mainlyfor older children. They afford freedom from theadult world, and therefore attract children in the agerange 10–12 years [3].

Playgrounds, then, are important outdoor environ-ments for children. And yet there are few play-grounds that are accessible to children with restrictedmobility. After searching in different databases (Ci-nahl, Eric, Medline, Architecture database, etc.) wefound only a few locations in the world where play-grounds have been designed so that they are accessi-ble to children with different types of activitylimitations [11–13].

Concerning the accessibility of different environ-ments to individuals with restricted mobility, researchhas recently begun to stress the importance of, andmake demands for, the accessibility of constructedenvironments to everyone—a social right for all citi-zens, irrespective of whether they are children oradults [14–16]. WHO’s international classificationsystem ICIDH-2 (1997) emphasizes the importance ofenvironment, which means that through insufficientaccessibility, an environment can cause participationrestrictions in various domains [17]. For children,there are certain demands included in the UnitedNations convention on the rights of the child, whose23rd Article states that ‘‘a mentally or physicallydisabled child should enjoy a full and decent life, inconditions which ensure dignity, promote self-relianceand facilitate the child’s active participation in thecommunity’’ [18].

In the theory formation of occupational therapy,the relation between person and environment is bytradition of central significance. As early as the 1950s,Reilly [19] discussed the interaction between personand environment and considered that one of the mostimportant tasks for occupational therapists is toadapt persons to a suitable environment and vice

versa, in order to improve their health. During the1970s and 1980s, Kielhofner [20] described the inter-action between a living system and its environment,holding that there exists a mutual dependence be-tween person and environment. In recent years, therehas been a growing interest [21] in the theoreticalmodel presented by the environment psychologistLawton [22, 23]. According to this model, thereshould be a balance between the capacity of theindividual and the demands of the environment, inorder to create a harmonious relationship betweenman and environment. This balance, according toLawton’s docility hypothesis, can be achieved in twoways—by adapting human capacity to the demandsof the environment, or by adapting the environmentto human capacity. Lawton considers further thatpeople with lower capacity than normal (e.g. childrenwith restricted mobility) are considerably more sensi-tive to the demands of the environment than individ-uals with higher capacity.

When a child with restricted mobility encountersan environment with limited accessibility, as is oftenthe case when the child is going to play in an ordi-nary playground, a situation arises in which there is,in Lawton’s [22, 23] terminology, an imbalance; theenvironment is not adapted to the child with lowercapacity. Occupational therapy research also showsthat children with restricted mobility seldom play inpublic playgrounds, but are obliged to use their owngardens [24].

In the light of these findings, the purpose of thisstudy was to find out what two groups of key per-sons—‘‘creators and users of playgrounds’’—in amedium-sized municipality in northern Sweden thinkabout accessibility.

MATERIALS AND METHODS

The municipality of Boden, located in the north ofSweden, has 30000 inhabitants and 117 playgrounds(in schools, public parks and housing areas). As wehad little knowledge in the field, we carried outinterviews with a number of key persons in order toacquire a clearer picture of the area under investiga-tion. First, we tried to find an informant, a personwho would be willing to act as a guide (to give usvaluable information) and tell us who we shouldchoose for the other key persons. This informant andthe first person interviewed was the Head of theParks Department. He selected the key personswhom he thought could provide the most informa-tion for us. They were: the Parks Department techni-cian, the Head of the Roads Department, a landscapearchitect and the Secretary for the Handicapped(handikappsekreterare). We then contacted three chil-

M. Prellwitz & M. Tamm168

dren with restricted mobility (aged between 7 and 11years) who lived in the municipality. We also con-tacted one of their parents, and their personal orschool assistant. These persons (the children, theparent and the assistants) were known to us througha previous study and participated in the present studyas key persons. The two groups were designated‘‘creators of playgrounds’’ and ‘‘users of play-grounds’’ (see Table I).

ProcedureEach of the persons in the investigation was con-tacted by telephone to make an appointment for theinterview. The interviews with the key persons whocreate playgrounds were carried out at their respec-tive workplaces. The interviews with the key personswho use playgrounds were, in the case of the parentsand the children, carried out in the children’s homes,the school and the personal assistant were inter-viewed in the schools. Each interview, which tookapproximately one hour, was carried out by the firstauthor and was tape-recorded and transcribed thesame day. The interviews were semi-structured andwere carried out in conversational form.

Analysis of inter�iewsThe interview transcriptions were analysed accordingto content analysis [25] into different themes. Thetranscribed interviews were first read independentlyby the authors. After the first reading, differentthemes were sought in the texts, with the purpose ofthe investigation in focus. In the interview texts for‘‘creators of playgrounds’’, questions that were raised

concerned: whether the creators had thought aboutaccessibility? What were the obstacles to creatingaccessibility? In the interview texts for ‘‘users ofplaygrounds’’, questions put were: What is it like toplay in a playground? Is help needed? What problemsarise? The analysis gave four themes for ‘‘creators ofplaygrounds’’ and two themes for ‘‘users of play-grounds’’. Those for ‘‘creators of playgrounds’’ were(i) fragmented organization, (ii) insufficient knowl-edge of disabilities, (iii) poor economy, (iv) attitudesas an obstacle, and for ‘‘users of playgrounds’’: (i) theplayground is not for me (i.e. for children withrestricted mobility) and (ii) personal assistance is aprerequisite for accessibility. The themes obtainedwere more or less the same for both authors, and theywere labelled jointly, with some fine adjustment ofthe content.

RESULTS‘‘Creators of playgrounds’’Under this heading, accessibility to playgrounds isaccounted for from the perspective of those whoparticipate or may possibly participate in the plan-ning stage when building a new or renovating an oldplayground in the municipality.

Fragmented organization (organizational difficulties)The interviews indicated that there are shortcomingsin the rules of procedure between the key personsinvolved (‘‘creators of playgrounds’’) within the mu-nicipality’s Public Works Office, but also in workingwith other departments in the municipality. Theseshortcomings include poor co-ordination, poor com-munication, and unclear or few directives. The ParksDepartment and the Roads Department are locatedon the same floor, but according to them there is nocooperation when it comes to the construction ofplaygrounds.

The landscape architect suggests certain playequipment, but the person purchasing the equipmentis, according to the landscape architect, often incontact with other companies in the sector and there-fore the equipment bought is not always the same asspecified on the blueprint. Furthermore, it was foundthat it was very much up to the people working in thedepartments themselves, depending on their interest,to get in touch with organizations for handicappedpeople and/or the municipality’s Committee for theHandicapped (handikappradet) for advice on accessi-bility, and the interviewees expressed hopes of in-creased cooperation in the future. This is whatpersons from different departments said:

Table I. Different key persons inter�iewed in the twogroups ‘‘creators and users of playgrounds’’ in thein�estigated municipality

Users ofCreators of playgrounds n=5 n=6playgrounds

1 Child 3Landscape architect*1Head of Parks 1 Parent

Department1Park technician 1Personal

assistantHead of Roads 11 School assis-

Department tantSecretary for the 1

Handicapped

* The landscape architect works in a larger, neighbouringmunicipality, but has knowledge relating also to this mu-nicipality.


Well, sometimes you ha�e to do a lot of searching, youha�e no clear indications of this particular questionbeing a problem and that we ha�e to put some extrathought into this particular feature when constructing.

... there should ha�e been more meetings; I see now,that I should ha�e done much more then, but the grouphad been dissol�ed by the time we’d finished the projectand I can’t really explain why there weren’t moremeetings, but it’s ob�ious more should ha�e been done.

The Head of the Roads Department said:

We ha�e worked �ery hard in parallel, but the ParksDepartment often works completely on its own.

The interviews showed that the municipality’sCommittee for the Handicapped gives its views onsome of the municipality’s various projects that con-cern public buildings and environments. The munici-pality’s Committee for the Handicapped is alsoconsulted on ‘‘bigger’’ issues, when questions ofadaptation for people with disabilities are dealt with,e.g. in connection with reconstructing traffic environ-ments and leisure facilities. The municipality’s Secre-tary for the Handicapped, (who is also a member ofthe municipality’s Committee for the Handicapped)when interviewed about playgrounds said, that thereare few representatives for children and young peoplein the Committee for the Handicapped.

You could say that the category, children, is not partic-ularly �isible in the Committee for the Handicappedand that it is mostly the adults with disabilities who arerepresented.

Projects such as, for example, the accessibility ofplaygrounds can then lack representatives. Further-more, it seems that many issues stop at the detaillevel and that one ‘‘cannot see the wood for thetrees’’.

Insufficient knowledgeSeveral of the interviewees declared that they pos-sessed insufficient knowledge of how to create play-grounds for children with restricted mobility. At thesame time, the issue of accessibility came as a surpriseto the interviewees. This was something they had notconsidered at all, on the admission of some of thosewho in fact create playgrounds.

No we ha�en’t thought about accessibility, not a jot,that’s the long and short of it. All I can say is, I ha�ememorized nearly all the playgrounds and we simplyha�en’t been thinking along those lines.

In the opinion of the Secretary for the Handicapped,there was insufficient knowledge among those who

read the blueprints and gave their views on accessibil-ity. At the same time, few experts in the field ofaccessibility were consulted. The Secretary for theHandicapped said:

It’s hard for ‘‘ordinary’’ people (the people in theCommittee for the handicapped) to ha�e the compe-tence necessary to read the blueprints and make theirown suggestions, when they don’t know what there is inother places.

Furthermore, it appeared that persons in the differ-ent departments were surprised that the constructionindustry did not possess more knowledge about adap-tation for people with disabilities, and it seemed thatit was often small details that could make big differ-ences, and that these small details that were includedin the blueprints disappeared, or were changed duringconstruction.

Some of the interviewees offered suggestions thatcould bring about better knowledge of adaptation.Others wanted more training and competence devel-opment in the field. In the words of one of theinterviewees:

... there should be more rules and regulations dealingwith what can be considered as adaptation for peoplewith disabilities.

In order to increase competence, it was also spon-taneously suggested that one could acquire assistancefrom other professional groups, e.g. occupationaltherapists, which had not previously been done.

FinancingThe interviewees stated that there were financial con-siderations that governed the design of playgrounds.‘‘The creators of playgrounds’’ considered that equip-ment adapted for children with mobility restrictionswas expensive, that it was expensive to adapt thesurfacing, but also expensive to consult other profes-sional groups on practical issues. When creating theonly playground in the municipality that is partiallyadapted for children with disabilities, which we hereshall call ‘‘the Snowrose’’, the intention was to installseveral pieces of play equipment that could beadapted to children with mobility restrictions. Butwhen tenders were offered, there were considerableprice differences between the equipment that was tobe adapted and the standard equipment. It was thenconsidered too expensive to carry out the adaptationand the cheaper alternative was chosen.

When the interviewees were told by the interviewerthat there were shortcomings in accessibility, both inease of entering the playground and in approachingthe play equipment, one of the interviewees said:


It is dreadful that they (children with restricted mobil-ity) cannot e�en get into playgrounds, but it’s a thingthat could be seen to immediately, the costs are so low.But rebuilding the playgrounds so that children withmobility restrictions can use them unaided, withoutthem being carried to the different play equipment,things like that would mean high costs.

AttitudesSeveral persons said that they had only half-heartedlydiscussed adaptation for children with mobility re-strictions when new playgrounds in the municipalitywere discussed, but that it never went further thanthat, with the exception of ‘‘the Snowrose’’ project.Plans for accessibility, then, were not followedthrough. And in the discussion about not adapting‘‘the Snowrose’’ playground any further, it wasbrought up that the children often have an adult withthem who can carry and help the child in the play-ground, and that it therefore was not necessary tocarry out other forms of adaptation.

We talked about it (accessibility), but we said that ifyou are wheelchair bound you can at least get into thisplayground and get to the centre of the playground;from there, we said, they always ha�e someone withthem who can carry the child.

The interviews showed that there had been nodiscussion about adaptation when other playgroundsin the municipality were renovated. Nobody had evenconsidered how a child with restricted mobility mightbe able to play in the municipality playgrounds. Norhad anyone—parents or any institution or author-ity—requested that playgrounds should be accessible.

‘‘It is largely a question of attitudes, of point ofview’’, some of the interviewees said. Since the ques-tions had not arisen, it had not been necessary to dealwith them.

‘‘Users of playgrounds’’Under this heading, accessibility to playgrounds isaccounted for from the perspective of the childrenwith restricted mobility and of those who help thesechildren in the playgrounds.

The playground that is not for meThe children interviewed told of how inaccessible theplaygrounds are, that they cannot even get into theplayground, often because of openings in the fencesthat were too narrow, sand that began right at theentrance, or because of a ditch that almost com-pletely surrounded the playground. One boy told of

how he could see the playground where his friendsplayed from his window. He could not take parthimself, because he could not drive his wheelchairinto the playground. One nine-year-old boy said:

My friends are often in the playground, but there, inour playground, there’s sand. What I want most of allin all playgrounds is tiles, because then I can get in. Ithink that ‘‘the Snowrose’’ (the playground partiallyadapted for children with disabilities) is best because ithas tiles, so I can at least get in there.

The playgrounds with accessibility through the en-trance seldom or never have accessibility all the wayto the play equipment. The children’s experience thenis that although they can get into the playground,they cannot play. The paths and trails that exist oftenlead only to the park benches or lead through theplayground. ‘‘Yes, I can drive through the play-ground, but I can’t play with the different things thatare there’’, an eleven-year-old girl said.

Opportunities to use the play equipment are alsolimited and according to the children only a fewpieces of play equipment are partly accessible in the‘‘the Snowrose’’ playground. The children also de-scribed that the traditional types of play equipment(slide, roundabout and swings) that are there are notaccessible to children with restricted mobility unlessthere is an attendant adult from whom to seek assis-tance. Several of the children said that they neededhelp at the swings, the climbing frame and the slidewhen playing in this playground.

The swings are so high, I get help from my mum, mydad, my brothers or grandma.

They lift me up onto the swing.

My assistant is there ... always.

Assistance is a prerequisite for accessibilityThe interviews with the school and personal assis-tants showed that a prerequisite for the children withrestricted mobility to be able to play in the play-grounds is that they receive help, from adults (parentsor assistants), as there is often no possibility for thechildren to get to the play equipment by themselves.These adults help the children in the playgrounds aslong as they can manage to lift and carry them to theplay equipment. The interview answers showed thatwhen the children get older and heavier, it is nolonger always possible to lift and carry as earlier. Theassistants described it as also psychologically trying,when they can no longer manage to lift and carry thechildren, and are forced to deny them the opportu-nity to play in the playgrounds.


You’d ha�e to be Superman. It’s all right when they’renot so big, but when they get a little bigger ...

It was all right as long as I could manage it. Saying noto him isn’t something I enjoy, exactly.

The school and personal assistants also reflectedover why the older children said that they did notwish to go to the playground, and thought that it wasbecause the children knew that their assistants couldnot manage to lift and carry them around in theplayground, and out of consideration for them, theyrefrained from asking to go there. When their friendsran to the playground, both the school and personalassistants saw signs that the children wanted to gowith them, but that they did not express such a wish.In the interviews, the assistants also said that theyrealized that without the help of an adult the childrenhad no possibility of playing in the playground.

You exert yourself a little too much, perhaps more thanyou should, but I’�e done it because I feel that they (thechildren) should be able to take part if they want to.

The parents interviewed have similar experiences,that playing in the playground is associated with lotsof heavy lifting. Playgrounds are places where chil-dren preferably are not left alone, because of theplaygrounds’ design. The sand on the ground is anobstacle:

She wants to go around with the other children, but thecrutches sink in the sand and she falls o�er.

The play equipment, too, was inaccessible to thechildren. The parent said:

If there had been paths up to the play equipment, andproper supporting rails on the play equipment, theaccessibility would ha�e been �astly impro�ed.

DISCUSSION

The results indicate that, in the municipality studied,there are many obstacles in playgrounds for childrenwith restricted mobility. That means that the childrenwith restricted mobility living in this municipalitycannot play in a natural way in the municipality’splaygrounds. This is contrary to the United NationsConvention on the Rights of the Child [18], whichemphasizes the right of all children to engage in play,to recreational activities and active participation inthe community.

If we interpret our results on the basis of Lawton’sdocility hypothesis [22, 23], in which the environmentis the playground, the demands imposed by thisenvironment are in most aspects too high for childrenwith restricted mobility. There have only been at-

tempts to adapt the child’s ability with the help ofpersonal or school assistants and technical aids, butno attempts have been made to adapt the environ-ment to the child’s ability. In order to strike somekind of balance between the child’s capacity and thedemands of the environment, the playground shouldbe adapted to reduce the demands of the environmentupon the children. Based on Lawton’s theory, byreducing the demands of the environment (play-ground) one can increase the activity of the individual(child). In occupational therapy, too, theories havebeen developed on the relationship between personsand the environment, and occupational therapistshave a considerable amount of knowledge to offerregarding environmental adaptations [4, 20, 21, 26].The fact that occupational therapists have not beenengaged as consultants in the creation of playgroundsis not surprising, because occupational therapists inSweden do not usually work within recreational envi-ronments, but they may play a significant role infuture planning.

The key persons who create the playgrounds admitthat they have insufficient knowledge about impair-ment and handicaps, and that their work methods donot naturally bring them into contact with thosepersons who possess such knowledge, i.e. personsfrom organizations for the handicapped. That therewas insufficient knowledge concerning impairmentand handicap also in the construction industry cameas a surprise to many of the key persons. Similarconditions were described by Iwarsson & Isaksson[27], who also see lack of knowledge and conser-vatism in the construction industry as obstacles to thedevelopment of accessibility in modern buildings.

The results indicate that insufficient knowledge isnot the only reason for the inaccessibility of playenvironments, but also a general lack of awareness ofthe needs of children with restricted mobility. Inter-views with those who create playgrounds, then, per-haps reflect the attitudes existing in society, whichcan be summarized in the saying, ‘‘out of sight, out ofmind’’. We could ascertain that there were no directlynegative attitudes among the interviewees, but rathera lack of awareness of the situation. Similar resultshave also been found in international research [15,27] (even though not dealing with playgrounds inparticular) showing that accessibility is not seen as aright, but is regarded more as a privilege or a ques-tion of benevolence.

The fact that economy can be an obstacle is awell-known phenomenon in all societies, includingSwedish society. The interviewees expressed views onthe costliness of adapting play equipment, but alsothe costliness of consulting other professional groups.According to Lawton [22], the problem of high cost is


often exaggerated—practical solutions are not alwaysnecessarily more expensive. An important practicalsolution would be to change the ground surfacing byextending pathways, so that the children can get intothe playground and get to the play equipment.

Among the ‘‘users of playgrounds’’, the children’saccounts showed clearly that they felt excluded fromthese play environments. They were, at best, specta-tors of other children’s play or completely outsidethese contexts. But playgrounds are not purely physi-cal places. Not having access to a playground deniesthe child both the opportunity to be in the playenvironment in question, and to be in the socialenvironment, i.e. the opportunity of interplay withone’s peers who play together at these places [8]. It isdifficult to say in what way such deprivation of playcan harm the development of children with restrictedmobility; for that, further studies are needed, follow-ing the child’s development over a period of time.Nevertheless, those who have studied children withrestricted mobility have shown that their play ishindered partly by the physical environment andpartly by their consequent lack of social skills. [5–7,24]. Further studies may clarify the developmentalpsychological aspects in more detail.

As shown by the interviews, playgrounds in themunicipality investigated were not built to be ac-cessed by children without the help of adults. Theinterviews show clearly that the personal assistant is aprerequisite if these children are to play in the play-ground. For the child, being constantly dependent onthe presence of an adult in a playground can be anobstacle to spontaneous contacts with other children,and in the long run, perhaps detrimental to his/hersocial development [5, 7].

From the personal or school assistant’s perspective,his/her role becomes not only physically strenuous,but also psychologically arduous when the child be-gins to be too heavy to carry, and must be refusedaccess to the playground. From an early age, childrenwith restricted mobility display a lack of interest inplaygrounds. Do the children discard the playgroundas an environment for play with their peers out ofconsideration for their assistants? Or is the personalassistant an obstacle when the disabled child seeks tojoin the social community of other children? Furtherresearch in this area may produce an answer to thesequestions.

CONCLUSION

To summarize, it can be said that playgrounds, whichare important outdoor environments for childrenwith restricted mobility, were perceived to lack acces-sibility in the municipality investigated. The fact that

the playgrounds lacked accessibility seems to havebeen a surprise to those who create these environ-ments. This means that the demands of the UnitedNations convention on the Rights of the Child, whichemphasizes the importance of recreational activitiesand active participation in the community, do notseem to have had much impact in the municipalityinvestigated. The result, then, can be said to be ratherdisappointing. This means that, owing to insufficientknowledge, children with restricted mobility havebeen excluded from environments that are importantto them, and they have been deprived of their justrights. The municipality investigated is just one ofmany municipalities in the county of Norrbotten, andtherefore one of the limitations of this study is that itis restricted to only one municipality, meaning thatthe results cannot be applied to other municipalitiesin Sweden. Conditions in other municipalities in Swe-den are a topic for study in our further research.

ACKNOWLEDGMENTS

The authors express their gratitude to those who partici-pated in this study. Further thanks are extended to ‘‘Savethe children’’, Sweden for financing the project.

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Accepted October 1, 1999

Address for correspondence :Maria PrellwitzHedenbrovagenSE-961 36 BodenSwedenFax: +46 921 75 850E-mail: [email protected]

.

Occup. Ther. Int. 14(3): 144–155 (2007)Copyright © 2007 John Wiley & Sons, Ltd DOI: 10.1002/oti

Usability of playgrounds for children with different abilities

MARIA PRELLWITZ and LISA SKÄR

ABSTRACT: The aim of the present study was to better understand how children with different abilities use playgrounds to engage in creative play and interact socially with their peers. Twenty children aged between 7 and 12 years, with different abilities, participated in interviews. The fi ndings showed that playgrounds served as a reference point for all the children, they challenged a child’s physical abilities and provided opportunities for role-playing and social interactions. However, for children with dis-abilities, playgrounds had limited accessibility, usability and did not support interac-tion with peers. A methodological limitation of the study was that the interviewer only met the children once. Further research should be carried out to investigate if creating playgrounds according to universal design principles and adapting them to the needs of children with disabilities would improve social interactions and provide more opportunities for play. Copyright © 2007 John Wiley & Sons, Ltd.

Key words: paediatric occupational therapy, playground accessibility, universal design

Introduction

Play is essential to a child’s development; it is regarded as an all-encompassing activity that helps to develop different skills such as social, intellectual, emo-tional and physical abilities (CAOT, 1996; Rodger and Ziviani 1999; Stagnetti, 2004). Playgrounds are designed especially for children, to play in, and they provide children with opportunities for both physical and social activities. In a playground, children’s awareness of their environment is developed, and while playing, children can learn social norms and values (CAOT, 1996; Stagnetti, 2004).

For children with disabilities these skills are important for their development; however, the physical environment of a playground can be diffi cult to master and thereby be an obstacle for participating in play activities (Tamm and Skär, 2000). Ground cover and play equipment are important factors to consider when planning or modifying playgrounds, in order to provide easy access and inde-

OCCUPATIONAL THERAPY INTERNATIONALOccup. Ther. Int. 14(3): 144–155 (2007)Published online 8 June 2007 in Wiley InterScience (www.interscience.wiley.com) DOI: 10.1002/oti.230

Usability of playgrounds 145


pendence for children with mobility limitations (Prellwitz and Tamm, 1999; Stout, 1988). For children with sensory limitations, play with sand, water and noise-makers has been suggested by Stout (1988). Occupational therapists could provide perspectives on playground design and equipment so as to develop playgrounds for children with and without disabilities (Stout, 1988). However, more information is needed about subjective experiences to better understand what makes playgrounds usable.

Policies – both international (UN, 1993) and Swedish (SOU 1997) – advo-cate children’s rights in society. Sweden’s National Action Plan on Handicap Politics proposes that all of Sweden should be accessible by the year 2010 (Regeringspropositionen, 1999/2000). In addition, in Sweden, since 1987, there has been a law stating that public places, including playgrounds, should be usable for people with disabilities (Plan-och bygglagen, 1987). In the USA the Americans with Disabilities Act (ADA, 2000) prohibits discrimination on the basis of disability in facilities such as playgrounds, and a national building code regarding play areas was developed in the year 2000. This code requires play-ground builders to plan for universal accessibility. In addition, accessibility should also include opportunities for children to engage in creative play in playgrounds while they are interacting with their peers (Hendy, 2001; Malkusak et al., 2002).

From the child’s perspective, what types of play activities do today’s play-grounds support and what is lacking? Listening to children with disabilities can help when designing playgrounds that are universally accessible and which promote social interaction.

In recent years occupational therapy research has focused not only on an environment’s accessibility but also on its usability. The concept of usability implies that a person should be able to move around, be in and use the environ-ment on equal terms with others (Iwarsson and Ståhl, 2003; Carlsson, 2004; Fänge and Iwarsson, 2005). Usability takes into account users’ subjective evalu-ation of effectiveness, efficiency and satisfaction when performing an activity. According to the defi nition of usability by Iwarsson and Ståhl (2003), the concept consists of three components: person (P); environment (E); and activity (A), that is, activity performance is a transaction between these three (P–E–A). The P component in the present study refers to children with and without dis-abilities. The E component refers to playgrounds and the A component refers to play activities on the playground. Another focus in recent years, both within occupational therapy and in relation to the concept of usability, is ‘universal design’. This focus supports the need for usability by designing products and environments that are usable by all people without specialized design, which may be stigmatizing (Ringaert, 2002). Universal design is a design approach that assumes that the range of people’s abilities is ordinary, not out of the ordinary (Ostroff, 2001). A well-designed playground using the principals of universal design can provide physical and social settings so that children with disabilities become part of the overall play experience (Goltsman, 2001). By gaining knowl-

146 Prellwitz


edge about playgrounds and the activities that are important to them from children we will increase our knowledge and increase the usability of play-grounds. The aim of the present study was to better understand how children with different abilities use playgrounds.

Method

Study design

A descriptive study design was chosen to elicit children’s attitudes and thoughts about playgrounds. The method selected for analysing the children’s experiences was content analysis, a method which elicits meanings and insights from the words of the respondents and identifi es patterns in data (Appleton, 1995).

Participants

Twenty children (9 girls and 11 boys; age range 7–12 years, mean age 9.4 years, standard deviation (SD) 1.67 years), with different abilities, participated in the study. There were five children with restricted mobility, five children with severe visual impairment, fi ve children with moderate developmental disabilities and five children without disabilities. All the children included in the study had good communicative abilities and the children with restricted mobility used assistive devices.

Procedure

The children with restricted mobility and developmental disabilities were selected with the assistance of two occupational therapists and psychologists from two children’s rehabilitation clinics in northern Sweden. Letters were sent to their parents requesting permission for the children to participate in the study. After consent was given a suitable time was arranged for an interview with child. The ethics committee at Umeå University, Sweden, approved the study.

Data collection

Data were collected by the fi rst author through an interview guide, together with an outline of topics to be covered (Kvale, 1996). The fi rst question was a broad one, asking the children to describe what they thought when they heard the word ‘playground’. After that, the interview focused on topics such as ‘Tell me about the playground at your school, what do you do on playgrounds, and with whom?’ and ‘What would you like to do at the playground that you cannot do today?’ The interviews were tape-recorded and took place in the child’s home or school, they lasted between 20 and 45 minutes.



Data analysis

Content analysis, by Catanzaro (1988), was used to analyse the interviews. The interviews were tape-recorded then transcribed verbatim. The transcripts were read through several times. The fi rst step was to divide the text into meaning units. In content analysis a meaning unit comprise a sentence or a paragraph which contains some understanding that the investigator needs, and a new meaning unit starts when there is a change in content or meaning in the text. The meaning units were identified, coded and then clustered through a process of comparison. The clustered meaning units were then condensed in order to make the text shorter but retain its core message. The text and the codes were read again and new codes with interpretations of the underlying meaning were generated. These codes were then sorted into different categories (cf. Catanzaro, 1988). After that, two different categories were formulated. Both authors dis-cussed the two categories and identifi ed sub-categories. To validate the catego-ries and the sub-categories both authors returned to the data and read through the text once again to confi rm the content of the formed categories.

Results

The analysis resulted in two categories with seven sub-categories (Table 1). The fi rst category describes similarities in the children’s experiences, regardless of their abilities. The second category describes the differences in experiences the children had.

Despite ability differences, playgrounds offer similar experiences

The children described many similar experiences of activities that take place on the playground. What differed between the children was the intensity and frequency of use of the playground, which depended on the children’s abilities and the accessibility of the playground.

TABLE 1: Overview of categories and sub-categories which were constructed from the analysis of the interviews with children

Categories Sub-categories

Despite ability differences, playgrounds offer A place everybody knowssimilar experiences A place for private conversations

Challenges for everybodyPlay equipment with a recognizable design

Dissimilar experiences as a consequence of A place to be with friendsthe usability of playgrounds Playing games or sitting on the swing

The design hinders play activities

148 Prellwitz


A place everybody knows

One similarity of the children’s experience of playgrounds was that all the children described their playground to be a place they knew very well and would miss if it did not exist. The children could describe in detail both the playground at their school and the playground closest to their home; this was regardless of whether or not they could use the playground. The children also stated that they used the playground as a reference point, the place you went to outdoors in your free time or the place where games started or ended, and, for some, it was a place to meet up with friends. The swings were described as the centre of the playground, a place for social gatherings or a place where it was OK to just sit when the children were by themselves. The swings were also described as the most important and usable play equipment, and for the children with disabilities, the most wished-for place to be in the playground. If most of the playground was diffi cult to get to, the swings were worth the effort to try and reach them.

Changes in their playground were also something all the children had expe-rienced: most of the time the children explained that these changes had made the playground less usable. Some children claimed that all the ‘fun stuff’ had been removed. Their experiences expressed a sadness that ‘their’ playground was gone, changed or that it was in need of repair. One child said, ‘I loved the little house, I had fun there, I don’t understand why they had to take it away’ and another, ‘I had fun there until they took all the things away.’ The children also described that these changes had happened without them understanding why.

A place for private conversations

Another fi nding was that the children described the playground as a usable place for privacy, away from adults, together with friends. Here, somewhere in a private corner – on the swing, on top of the jungle gym or on a bench – private conversations took place. For the children with disabilities this was mostly expressed as a wish or as something that had happened once or twice, but it was something they remembered as significant. This ‘sitting around talking’ was perhaps the most important activity on the playground, and all the children expressed that these conversations should take place where there were no adults present. The children also expressed wishes for benches, houses and other equip-ment at the playground that would support this activity. One of the children said, ‘I can crawl to the swing and then we can sit and talk; we don’t play any-thing we just talk about different things.’

Challenges for everybody

The playground was, according to the children’s experiences, a place for activities that posed some sort of challenge. However, the kinds of challenges they described



were different depending on the children’s abilities. For example, a challenge for the children without disabilities could be to perform activities that were forbid-den by the adults, such as hanging upside down or sitting on the highest point on the jungle gym. One child stated, ‘Almost everybody tries to hang by the knees. I know we are not supposed to, but it is fun and scary. I like to see my feet and say “Hi feet”.’ To reach the highest point on the jungle gym or the roof of a playhouse, both children with and without disabilities mentioned as a chal-lenge – either something they did or something they wished to do. For the chil-dren with disabilities other challenges were described, for example trying to use play equipment never tried before or to do an activity on the playground without an adult there to assist them. This was expressed in the following ways, ‘I tried to climb up the slide, it’s hard but its fun, I can do it all by myself’ and ‘I have a slide by my house I can play there without my mother being there.’

Play equipment with a recognizable design are more usable

Another experience that was similar between all the children was that some playground equipment promoted role-playing on the playground. According to the children, these role-playing activities were usually created around play equip-ment with a recognizable design, that is, things shaped like a house, a car, a boat or an animal. The playhouse produced a number of activities, such as playing ‘store’, ‘school’ or ‘family’. The playhouse could also serve as a jail or a place where the witch or monster lived. Most of the children expressed a wish for these kinds of play equipment since, according to them, very few playgrounds had them. Play equipment shaped in other recognizable designs produced role-playing activities as well. One child said, ‘I wish for a roof and a house and a store and a car. I play with my friend until dark’ and another, ‘I wish they would get rid of the old swings and the jungle gym, I want a playhouse where I can play, hos-pital, bank, bakery, café, bowling ally, fl orist, hockey rink and I want a new bas-ketball hoop.’ The activities that these designs generated seemed to hold the children’s interest for a longer period of time than the jungle gyms and slides.

Dissimilar experiences as a consequence of the usability of playgrounds

The children’s descriptions of dissimilarities in playground usability, attributed to the environment and the children’s different abilities, were also evident. These fi ndings showed that, compared with children without disabilities, chil-dren with disabilities lacked a number of opportunities to use this environment and if they could use it they were not on equal terms with others.

A place to be with friends

The children without disabilities experienced the playground as a meeting place; this was, according to them, a place were you never played alone. If you

150 Prellwitz


came to a playground by yourself you either waited for your friends to arrive or you made new friends with the children who were already at the playground. The experience of the children with disabilities was different: they were seldom with friends at the playground. One child said, ‘Once I was with a friend at the playground, we sat on the swings, but it was only once.’ None of the children with disabilities mentioned ever making new friends at the playground.

For the children with disabilities the school playground was diffi cult to use and they rarely got help from adults, whereas at the playground by their home an adult was necessary if they were to use the playground at all. A visually impaired child said, ‘I’m always with an adult, I wish I could sit on the swings with the others.’ The experience of the children without disabilities was that they rarely had an adult with them. If they did the adult would never participate in playing, they would only sit on the park bench and watch.

Playing games or sitting on the swing

One of the dissimilarities between the children with and without disabilities was in their description of their play activities and how they used the playground equipment. According to the children without disabilities, play activities in the playground had names, usually involved other children and they used the play-ground equipment in many different ways. For example, the slide was a moun-tain to climb where the camp was underneath or the swing could be a boat that carried them over the ocean. One child expressed it this way, ‘On the big slide we play crocodile, you try to climb up but the crocodile pulls you down.’ The children with disabilities, on the other hand, did not describe these kinds of play activities; their play activities had no names and, for example, the slide was something you climbed up and went down or the swing was something you sat on. One child with restricted mobility said, ‘I sit in the sandbox or I sit on the swing.’ These descriptions lacked interactions with others.

The design hinders play activities

The usability of playgrounds, according to the children with disabilities, depended on their design. For the children with restricted mobility, sand was their biggest obstacle, but they also stated that the playground equipment was too small for them to manoeuvre around if they had some sort of mobility device. For example, if the child could enter the playhouse using a wheelchair they could not turn the wheelchair around inside the playhouse and therefore had a diffi cult time getting out again: ‘I wish for a path made of wood so that I could use my wheelchair and that things was sort of bigger.’ Their experience was that the playground was a place they did not visit much. According to these children, the playground equipment was only for smaller children, ‘It’s mostly little kids there, I don’t know why I’m not there, it’s really not a problem I can get in with the wheelchair to the playground I just have to toil and moil (work



hard).’ For the children with visual impairments the grey wood which play-ground equipment is often constructed from made it diffi cult for them to see stairs and barriers. They also wished for playgrounds to be closer to the school building so it would be easier to fi nd them and also it would be easier for them to know if the other children were there. The experience of the children with developmental disabilities experiences was that a lot of the playground equip-ment was complicated to understand, for example it was hard to understand where to start and how to use large, multi-functional jungle gyms with slides and ropes to climb. Swings and other equipment that was for sitting on were often too small for them. Both the children with visual impairments and those with developmental disabilities expressed that they did not want to try some playground equipment when other children were present because they were afraid they would not use the equipment the right way and would be teased by the other children. Instead, they would sit and wait until they were by them-selves and then try. The children without disabilities never mentioned any problems with playground equipment. Their experiences of playgrounds were that this was their place and they spent a lot of time there.

Discussion

The aim of the present study was to better understand how children with dif-ferent abilities experience usability in playgrounds. In the study it was evident that all the children, regardless of their abilities, had experienced playgrounds and that they were a special place they did not want to be without. The most important function the playground had, according to the children, was to offer social interaction with peers. They were also seen as an important place to have private conversations, meet friends or make new friends. The fi ndings also showed that, regardless of the children’s abilities, there were many similar expe-riences of the activities that took place in playgrounds. When integrating the P, E and A components, according to the Iwarsson and Ståhl (2003) defi nition of usability, the results showed that the P component (the functional capacity of the children) was quite heterogeneous and that the E component (the play-grounds) was quite different, while the A component (play) had several similari-ties. To focus an enquiry on the A component seemed, in this case, to add to our understanding of usability.

The results also showed that all the children, regardless of ability, sought challenges or risks on some level. According to Rodgers and Ziviani (1999), experience of challenges, disappointments and failures are common human experiences which can be experienced in a supportive play environment. Often, children with disabilities are overprotected by well-meaning parents and care-takers. According to Mårtensson (2004) the jungle gyms with several climbing functions are one attempt to meet children’s needs for challenges; however, children are capable of creating their own challenges, with a diversity of experi-

152 Prellwitz


ences where the challenge was more on a mental level. Therefore can today’s modern playgrounds, built on small areas with one or two large multi-functional jungle gyms, seem boring to children and make them look for challenges elsewhere (O’Brien and Smith, 2002; Mårtensson, 2004; Solomon, 2005). In the present study, children looked for challenges but none of them wished for large multi-functional jungle gyms; instead, all the children wished for more recognizable things or ‘real things’, meaning houses, cars and boats. According to Mårtensson (2004), it is around these ‘real things’ that play on a more mental level, such as fantasy play and role-playing, has a tendency to take place. Creating playgrounds that have more ‘real things’ which promote fantasy and role-playing might also encourage more social interaction between children.

Play activities on the playground were described by the children in the present study in two different ways. These two different ways could be illustrated by two core concepts in occupational therapy: activity and occupation (Golladge, 1998; AOTA, 2002; Royeen, 2002). The children without disabilities described most of their play activities on the playground as an occupation, that is, activi-ties that had a unique meaning and a purpose. This occupation was central to their competence, and the occupation play influenced how they spent their time and made decisions on the playground. The children with disabilities, on the other hand, described most of their play as an activity, for example the goal was to sit on the swing or go down the slide, and the children’s experiences did not describe a unique meaning or purpose. The only time they described their play activities more like an occupation was when they played on equipment with a recognizable design. Their descriptions did not, for the most part, reflect the complexity that is play, the imaginary world that children create while interacting with their peers. Therefore, instead of concentrating only on play-ground equipment, measurements and meeting accessibility standards, it is important to focus on designing opportunities for interaction. In the concept of universal design the value of standards and rules is recognized; however, compliance to these alone does not guarantee accessibility for all. Instead, universal design focuses on the inter-relationship between the physical environment and the user, with emphasis on social inclusion (Ostroff, 2001). Examples of universally designed objects, pedestrian crossings and residential environments, have proved to be useful for everybody not just for people with disabilities. Playgrounds should incorporate universal design principles so that children with different abilities can fully enjoy and participate in outdoor play activities.

In the past, within occupational therapy, play has been used mainly as a tool to reach therapeutic goals. However, in recent years, play has started to be seen as a need-fulfi lling and appropriate occupation in the life of all children, and occupational therapists are starting to promote play as an occupation in itself (CAOT, 1996). Focusing on usability in playgrounds will attract attention to a problem at a societal level; doing this demands knowledge about the



functional limitations of the target group, about accessibility of the environ-ment, but, perhaps most of all, the subjective evaluation of the target group of the activities that are to be performed in the specifi c environment. When the focus is on a societal level the concept of universal design should also be addressed. Having knowledge about how to integrate the needs and abilities of all children, together with occupational therapists’ knowledge about play as an activity and the of concept universal design, we should be able to provide support when creating universally designed playgrounds, an environment which supports a range of mental and physical challenges, promoting interaction and communication, and giving children a choice of challenges (Goltsman, 2001; Ringaert, 2002).

Methodological consideration

The strength of the present study lies in the insider perspective of children’s experience of playgrounds. Strategies used to enhance the credibility of the study were used in the interview process to reframe and repeat questions asked during the interview and the interviewer having had experience in interviewing children. The use of citations from the interview text was also a strategy to enhance credibility. To enhance dependability and confi rmability, the methods of data collection and analysis were described in detail and the analysis was done separately by the two authors. One limitation might be that the inter-viewer only met the children once, and thus could not detect any possible mis-information in the children’s answers (Lincoln and Guba, 1985).

Conclusion

The results from the present study indicate that playgrounds are important environments for all children, regardless of their abilities, but they are not acces-sible and usable for all. The results also indicate that playgrounds do not fully support play activities for children with disabilities. This, in turn, might affect their opportunities to play and interact with their peers. However, a new approach to designing playgrounds is to consider the activities that children undertake on playgrounds. The playground should not only be a place for physi-cal play activities, but should be a meeting place where play and social interac-tions take place. Playgrounds are a public environment according to Swedish law and they should therefore be universally designed. Occupational therapists, with their knowledge of environmental barriers, understanding of disability and specific knowledge of activities, are in an ideal position to develop and maximize play activities on playgrounds to increase their accessibility and usability. They are also in a position to educate and advocate for universal design to decision-makers. The focus of the occupational therapists’ support should therefore be on both individual and societal levels.

154 Prellwitz


Acknowledgement

The authors would like to thank the children who participated in the study and the occupational therapists who helped to select the participants. The study was supported fi nancially by a grant from Norrbacka – Eugeniastiftelsen and Luleå University of Technology.

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Address correspondence to: Maria Prellwitz, Department of Health Sciences, Luleå University of Technology, SE-971 87 Luleå, Sweden (E-mail: [email protected]).

How playground designs influence children with disabilities - parental perceptions

Maria Prellwitz¹ & Lisa Skär¹

¹ Department of Health Sciences, Luleå University of Technology

ABSTRACT

Objectives of study: The aim was to gain increased understanding of how playground

designs can influence a child with disabilities.

Methods: Eighteen parents of children with disabilities participated in the interviews.

Results: The findings showed that parents perceived that playground designs influenced their

children in different negative ways, by hindering play activities and interaction with peers.

The parents also perceived that playgrounds caused the children to feel different from their

peers and that the children thereby avoided being in playgrounds.

Limitations and recommendations for further research: A methodological consideration

was the lack of variations between the parents’ perceptions, which is a central issue in

phenomenographic studies, perhaps because all the parents had similar negative experience of

this environment. Further research should investigate the role of occupational therapists

working on environmental changes on a societal level.

Key words: pediatric occupational therapy, parents, playgrounds, phenomenography

Playgrounds are a common place that can be found in most cities, towns, neighborhoods, and

schoolyards in the western world (Thompson, Hudson, and Bower, 2002). Playgrounds as an

environment that enables or hinders play activities for children with disabilities has received

little attention in occupational therapy research (Rigby and Letts, 2003). A few studies have

addressed the issue regarding the number of playgrounds that are accessible for children with

disabilities, and concluded that it is uncommon to see playgrounds designed and built with

this intention (Stout, 1988; Thompson, Hudson, and Bower, 2002). According to a Swedish

report, only 1% of the countries’ playgrounds are built with the intent of being accessible for

all children (RBU, 2006). In a study (Prellwitz and Skär, 2007) regarding children’s

experience of playgrounds, the results indicated that the playground design did not support

play activities and participation with peers for children with disabilities, whereas children

without disabilities described playgrounds as an important place to meet and play with

friends. Therefore, it is important to study how lack of accessibility to playgrounds and

participation in play activities can influence children with disabilities.

Participation in different play activities often takes place on playgrounds during school recess

and after school and is important for children’s social life (Smyth and Anderson, 2000). In a

longitudinal study (Blatchford, 1998) of British children, results showed that friendship

develops during school recess in conjunction with play when children begin their first school

year at around 7 years of age. According to this longitudinal study, play during school recess

seems to peak when the children are 8–10 years of age and it is during this time groups come

together and lasting friendships are formed. According to several studies, lack of friendship

with peers and lack of opportunities to participate in play activities is a problem for children

with disabilities (Brown and Gordon, 1987; Bedell, Haley, Coster and Smith, 2002). For

parents of children with disabilities, this is also one of their concerns; that is, how to promote

forming friendship and participation in play (Bedell, Cohn, and Dumas, 2005). According to a

recent research on occupational therapy (Law, Finkelman, Hurley, Rosenbaum, King, King,

Hanna, 2004; Heah, Case, McGuire, Law, 2007), environmental factors have been found to

have the biggest impact on participation in play activities for a child with disabilities, not the

child’s diagnosis.

In playgrounds, at least in Sweden, environmental factors are a big reason why children with

disabilities have problems participating in play activities. Decisions regarding the design and

2

building of playgrounds in the western world are on a societal level and there are several laws

and conventions (Plan- och bygglagen, 1987; United Nations 1989; United Nations, 1993;

ADA, 2000; Office of the Deputy Prime Minister, 2003; United Nations, 2006) that supports

the view that playgrounds should be accessible and usable for people with disabilities.

According to the concept of universal design, it is possible to build playgrounds that integrate

the needs and abilities of all children into the design. A universally designed playground does

not need to be high-tech; it needs innovative thinking, problem solving attitude, and user-

based data on occupational performance. By providing a diverse physical environment with

different kinds of challenges and a social environment with gathering places that are

accessible to all to promote social interaction, children with disabilities should have less

problems participating in play activities in this environment (Goltsman, 2001). Occupational

therapists should therefore work together with people with disabilities toward societal changes

to enable occupational performance (Ringaert, 2002). The need to change the environment on

societal level coincides with the social model of disability (Oliver, 1983). This model claims

that problems for people with disabilities are consequences of disabling environments that

contain barriers, thereby excluding people with disabilities from performing activities.

Occupational therapy can contribute to the process of creating a nondisabling environment by

entering into a dialog with people with disabilities to discover effective ways of enabling

occupational performance (Hunt, 1996).

The research review reveals that children with disabilities have limited opportunities to play

on playgrounds, and this depends largely on the way playgrounds are designed today. After

interviewing children with different abilities regarding their thoughts about playgrounds, it

also seemed important to obtain the parents’ perception on this issue. Parents’ perception can

add valuable knowledge into some of the environmental factors that exist on playgrounds for

children with disabilities, and can explain how this in turn influences their children. This

knowledge can be of importance when designing playgrounds for all children, and important

for occupational therapy interventions. Therefore, the aim of this study was to gain increased

understanding about parents’ perception of how playground designs influence their children

with disabilities.

3

Method

Design

A descriptive and qualitative design using a phenomenographic approach was chosen to

understand and describe the phenomenon “how children with disabilities are influenced by

playgrounds design.” Phenomenography is an explorative way of doing research from

empirical data to discover differentiated categories that give descriptions of the phenomena in

the world as people see and describe them in various ways (Barnard, McCosker, and Gerber,

1999; Marton and Pong, 2005).

Participants

Eighteen parents of children with different disabilities aged between 7 and 12 years of age

participated in the study. Six parents had a child with moderate developmental delay, six

parents had a child with restricted mobility where the use of assistive device was necessary,

and six parents had a child with severe visual impairment (Table 1).

Table 1 Demographic characteristic of the parents and children with disabilities

Interview Gender and Gender and Child’s diagnosis

number age of parent age of child

1 Male 39 yrs Boy 7 yrs Moderate developmental disabilities

2 Female 32 yrs Boy 8 yrs Moderate developmental disabilities


4 Male 49 yrs Boy 12 yrs Moderate developmental disabilities


6 Male 45 yrs Girl 11 yrs Moderate developmental disabilities

7 Female 35 yrs Girl 12 yrs Arthrogryposis

8 Female 42 yrs Girl 9 yrs Cerebral palsy (CP) GMFC III

9 Male 37 yrs Boy 10 yrs Cerebral palsy (CP) GMFC III

10 Female 43 yrs Girl 9 yrs Arthrogryposis

11 Female 32 yrs Boy 7 yrs Spinal Muscular Atrophy III (SMA).

12 Female 37 yrs Girl 11 yrs Cerebral palsy (CP) GMFC IV

13 Female 29 yrs Boy 7 yrs Severe visual impairment


15 Male 40 yrs Boy 9 yrs Severe visual impairment

16 Female 40 yrs Girl 8 yrs Severe visual impairment

17 Female 45 yrs Girl 12 yrs Severe visual impairment


GMFC= Gross Motor Function Classification

4

Procedure

The parents of children with restricted mobility and moderate developmental delays were

selected with the assistance of two occupational therapists and psychologists from two

children’s rehabilitation clinics in northern Sweden. The parents of children with visual

impairment were selected with the assistance from the Swedish Association of Visually

Impaired Youth. Letters were sent to the parents, asking them if they were willing to

participate in the study. In the letter, the aim of the study was presented, and the fact that all

data would be treated confidentially, and that they could terminate the participation was

mentioned. A signed consent form was sent back to the first author, who then contacted the

parent to give verbal information about the study, and to arrange a suitable time and place for

the interviews. The ethics committee, Umeå University, Sweden, approved the study.

Data Collection

Data were collected by the first author through semi-structured interviews using an interview

guide with an outline of topics to be covered (Kvale, 1996). The first question was a broad

one asking the parents how they thought their child was influenced by the playground design.

After that, the questions focused on topics such as: Does your child play on the school

playground? Does your child play on the playground near your home? Depending on the

answers, one follow-up question was: How do you perceive that playing on these playgrounds

has affected your child? The focus of the question and the focus of this article are on the

children. The interview was carried out as a dialog to grasp the aspects of the person’s

awareness that changed from being unreflected to being reflected. The interviews were tape-

recorded and took approximately 45 min to 1 h. After each interview, the first author

transcribed the interviews verbatim.

Data analysis

Using a phenomenographic data analysis, the intention is to identify the meaning and content

of perceptions, and to present them in descriptive categories that describe variations in the

way people experience a phenomena (Marton and Booth, 1997; Barnard, McCosker and

Gerber, 1999). The transcripts of the interviews were read through several times for overall

comprehension. After this, the interviews were analyzed for the purpose of finding relevant

statements that contained perceptions of how the parents thought their child was influenced by

playground designs. The analysis focused on comparing the statements to find similarities and

differences. Perceptions that described different aspects of the same issue were then grouped

5

together into patterns. These patterns emerged into four descriptive categories. In this study,

the first author conducted the analysis, whereas the second author served as a peer reviewer

by placing all the statements from the interviews to one of the eleven perceptions that the first

author had found after analysis. In this step of the analysis both the first and second author

had an 87% agreement. The next step of the analysis was for the second author to place the

eleven perceptions to one of the four descriptive categories that the first author had formed;

here, both the first and the second author had a 100% agreement.

Findings

Four descriptive categories comprising 11 perceptions were constructed according to the

descriptions provided by parents of their perception on how their children are influenced by

playground designs (Table 2).

Table 2. How playground designs influence children with disabilities based on the parents’ perspective.

Descriptive categories

n=4

Perceptions

n=11

Number of statements n=327

Number of interviews

n=18

Playground design makes play activities and independence difficult.

A need for different things

The environment

rules

28

20

1–4,6–8,11–15

2–4,6–7,9–11,14,16,18

The playground design hinders interaction with peers.

If more independent more friends

Lack of participation in activities

Would be happy just to be close by peers

51

28

9

1–11,14,16–18

1,5–11,14,17–18

3–7,11

An environment that creates negative feelings.

Makes them feel different

Avoids them

Society should do something

65

38

31

1–4,6–11,12–16,18

1–4,6–15,17–18

2,5–14,16

An environment circumvented.

Never considered playgrounds a place to go

A problem never discussed

That’s just the way it is

22

18

17

1,3–5,7–9,12,14–18

1,3–5,9,11–12

3–9,12–13

6

Playground design makes play activities and independence difficult

This descriptive category comprises the two perceptions: ‘a need for different things’ and ‘the

environment rules.’ When reflecting over playground designs in relation to their children,

most parents described that playgrounds were an environment filled with difficulties for their

children to use in play activities. The first perception described that the parents reflected over

solutions to make the playground more useable for their child. If the playground had

contained simpler play equipment, movable toys or playhouses, their child could have used

more things on the playground for play activities. If the ground cover and design of equipment

had been different, their child could have also used more of the playground. “Make the

playgrounds more colorful and things that are easier to use, it would not just benefit the

children with visual impairment.” The second perception had to do with how the

environment puts limits on the child’s whereabouts, and how it also made the presence of the

parents a necessity when visiting playgrounds. “The opening in the fence (the entrance) is not

big enough for her to enter by herself I have to help her, so I have to go with her every time.”

“I have to send him to a different school than his friends in kindergarten because it is more

accessible and the schoolyard too.” The parent’s perceptions in this category expressed that

playground designs influenced their child’s ability to play there in a negative way. The

playground design also required the presence of someone who could help, influencing their

child by making them feel dependent on someone, if they wanted to play there.

Playground design hinders interaction with peers

This descriptive category comprises the three perceptions: ‘if more independent, more

friends,’ ‘lack of participation in activities,’ and ‘would be happy just to be close to peers.’ In

this category, the parents’ answers described that they perceived their child had missed

opportunities to make friends at the playground. The first perception described that if the

playground had been more accessible, the child could have been more independent and the

parents would not have been an obstacle for their children’s interactions with peers. “I feel

that I am with him too much, the other children ask me instead of talking to him it feels like

I’m in the way.” The second perception refers to the parent’s statements that their children are

mostly onlookers to other children’s play activities because of the playground design. “He

does not want to be part of outdoor play activities any more; he feels that he just sits there.” It

7

also refers to the parents’ perceptions about how much more their child would have been able

to participate in activities on the playground, if the environment had been more accessible.

The third perception refers to parents describing that their child sometimes cannot even get

close to the playground where the other children are. “I am convinced that she would be

pleased if she could be where the others are. I am telling you to be an onlooker is okay for her

but if there is something in the way she is no longer an onlooker, she is an outsider.” The

parents’ perceptions in this category expressed that lack of accessibility influences their

children by denying them opportunities to participate with other children in play activities.

An environment that creates negative feelings

This descriptive category describes three perceptions: ‘makes them feel different,’ ‘avoids

them,’ and ‘society should do something.’ In this category, the parents described that

playgrounds are an environment that influences their children by creating feelings of

insecurity and embarrassment—an environment that clearly made their child feel different

compared to their peers. The parents also described that being on the playground is

embarrassing for their children when they are reminded that they cannot use the playground,

or be there on the same terms as other children. “She is a child with a handicap and she

comes crawling, the other children think that she is much younger than what she is, if she

could make it to the swings like the rest of them she would not be so different.” Playground

designs also influence the parents by creating negative feelings. The second perception

describes how the parents perceived that the children found excuses for not going to the

playground, and that the children simply stopped asking to go there. The parents also

described that they avoided playgrounds as well: not only did they express different reasons

for not going there, but also declared that they had not really been there and expressed guilt

feelings about not being on playgrounds more often. “ It might be up to us parents, we have

not encouraged her to go there because it is just too darn much, too demanding and also it is

a big sorrow to watch the other children play I feel really guilty at times that I have not meet

her needs.” The third perception refers to the parents describing that a change in playgrounds

was needed, and that it should be society, not them, that should be responsible to ensure that

these changes take place. If playgrounds had been more accessible and had different

equipment, more opportunities for their child to play and interact with peers would have been

possible. “Society should be equal for everybody then everybody should have the right to

play.” The parents’ perceptions in this category expressed that playgrounds caused their

8

children to have negative feelings, and that this in turn is a problem that society should do

something about.

An environment circumvented

This descriptive category comprises the three perceptions: ‘never considered it a place to go,’

‘a problem never discussed,’ and ‘that’s just the way it is.’ This category is about how parents

perceived playgrounds, which in turn has influenced their children’s opportunities to visit

playgrounds. The first perception described that the parents never had thought about

playgrounds as a place to visit because of all the difficulties that was involved both for them

and for their children. “ There is no chance that he can play there in that case I have to be

active the whole time, no it isn’t a place for fun for us.” Regarding the second perception,

most parents had never heard their child mention playgrounds, which made them assume that

their child did not want to talk about it. The subject was also avoided by the parents because it

became too obvious that activities on the playground was something their child was missing

out on. Playgrounds were a subject circumvented both in reality and as a subject for

discussion by both the parents and children. “We never discuss it, and we never think to ask

about it either, although we would be happy if the playground was accessible and so would

he”. The third perception showed that the parents had resigned themselves from the situation,

that is, given up. The fact that their child had a disability was, according to the parents, the

reason that made it difficult or impossible for the child to use the playground. There was

nothing to do about it and the parents never thought that this environment could become

accessible for their child. “That’s the way it is going to be, you have to accept that she has

difficulties with her motor control so I have to carry her, that’s reality.” The parent’s

perceptions in this category expressed playgrounds as a place that both their children and

themselves had a quiet agreement because inaccessibility in this environment for the most part

was a hindrance in performing the activities that playgrounds are intended for. The category

also expresses the fact that the parents perceive that the problem was because of the

disability, and that it was not an environmental problem.

Discussion

The aim of this study was to describe parents’ perception of how playground designs

influence their children with disabilities. The findings indicate that playgrounds influence

children with disabilities in a number of different ways, all of them negative. According to the

parents’ perception, the playground influenced their children by making them feel insecure,

9

embarrassed, and different from other children, and that their child therefore avoided being

there. Earlier researches (Nabors and Badawi, 1997; Pollock and Stewart, 1998; Skär and

Tamm, 2000) described how children with disabilities, with regard to play activities, often

feel alienated and different from peers. Feeling different and not being able to use

playgrounds the same way as other children can be stigmatizing. The consequences of

stigmatization can in turn result in exclusion from participation in play activities. To avoid

being stigmatized, children with disabilities can chose to develop a “stigma management

technique” (Segal, Mandich, Polatajko, Cook, 2002) which in this case would mean avoiding

playgrounds. This in turn can limit the social life of the children, as seen in the results of this

study.

Playgrounds were also a place avoided by the parents perhaps as a “stigma management

technique.” However, after reflecting on playground designs, the parents felt anger toward

society, questioning as to why nothing was done about playground accessibility for children

with disabilities. Universal design could be a strategy to use when designing and building

playgrounds because the concept ‘universal design’ is mostly about changing attitudes

throughout society with an emphasis on democracy and equality to avoid stigmatization and

segregation (Iwarsson and Ståhl, 2003). In the concept, the focus is on making environments

accessible by accommodating not only the physical needs, but also the psychological and

behavioral needs where the needs of all user groups are considered (Ringaert, 2002). As

occupational therapists work to facilitate participation in life’s occupation to promote health

and well-being and have a great deal of knowledge regarding disability, environment, and

activity, they would be good consultants in supporting the universal design concept when

designing and building playgrounds.

Further, parents described that playgrounds influenced their children by hindering them from

performing play activities on the playground. This also influenced the children in a negative

way by making them feel different from other children. Children with disabilities are often

deprived of the opportunity to engage in play. As a result of this, children can experience

decreased motivation, lack of assertiveness, and low self-esteem (Missuna and Pollock, 1991).

Ideas about how some changes in the design would make the playground more accessible to

perform play activities were described by the parents, although they had not asked or

demanded any changes. They even thought there has been a law in Sweden (Plan- och

bygglagen, 1987:10) for 20 years stating that playgrounds should be accessible for persons

10

with disabilities. Similar laws can be found in other countries. The authors’ interpretation of

this is that the parents do not see playgrounds as something included in this law (Ibid.)

regarding accessibility and that they therefore do not have the right to demand accessibility in

this environment. Considering the low percentage of accessible playgrounds, one might

assume that persons responsible for playgrounds have made the same assumption that this law

does not apply to playgrounds. However, a new law (SOU, 2006:22) is being considered in

Sweden that will make it an act of discrimination if built environment is not accessible,

similar to the Americans with Disabilities Act (ADA, 2000) that prohibits discrimination on

the basis of disability in facilities such as playgrounds. If this new law comes into effect, one

can only hope that both parents and policy makers realize that playgrounds are included in the

built environment. This could result in accessible playgrounds with possibilities to play, and

thereby reduce the risk that children with disabilities are influenced in a negative way by

playground designs.

The results indicate that playground designs influence children with disabilities by limiting

participation with peers. According to the International Classification of Functioning,

Disability and Health [ICF], participation is necessary for the well-being and health of

children with disabilities (WHO, 2001) and is the primary goal of occupational therapy

interventions for these children (Law et al., 2004). The parents perceived that lack of

accessibility and therefore lack of possibilities of participation make their children more

dependent on them, the parents. Limited participation in play activities for children with

disabilities can, according to many researchers (Brown & Gordon, 1987; Mulderij, 1996;

Nabors & Baldawi, 1997), lead to poor social skills, limited intrinsic motivation, decreased

concentration, and more solitary play or play with adults. Therefore, the design of

playgrounds should be more about participation, about being able to interact with peers in

play activities (Goltsman, 2003). This could reduce the risk that children with disabilities feel

different and are less influenced in a negative way by playground designs.

Methodological considerations

The trustworthiness in this study was built on the use of a co-assessor (Marton, 1981) with a

high level of agreement when independently placing the statements into different conceptions

and then into different descriptive categories. The agreement was within the range of what is

recommended for phenomenographic studies (Uljens, 1989). In addition, the study’s

11

dependability was strengthened by showing how the analytical process was achieved

(Holloway and Wheeler, 2002). As the aim of phenomenography is to qualitatively investigate

the different ways in which people understand an aspect of the world around them (Marton

and Pong, 2005), a methodological consideration was the lack of variations between the

parents’ perceptions. However, according to Uljens (1989) there are only a limited number of

different qualitative ways to perceive a phenomenon or situation.

Conclusion

The findings from this study show that playground designs influence children with disabilities

in a negative way, according to their parents’ perception. Missed opportunities to participate

in play activities and dependence on support from adults can result in fewer opportunities to

social interaction with peers, which in turn might result in fewer opportunities to learn

valuable social skills. Another negative influence that the parents reported was that

playgrounds made their children feel different if they went to a playground or that they

avoided participating in activities on playgrounds so that they would not feel different.

The results of this study reveal that an environment that is created especially for children

might, for children with disabilities, be an example of how an environment can cause

limitations both in activities and participation, and can cause stigmatization and play

deprivation.

Acknowledgement

We would like to thank all the parents that participated in the study. Further thanks are

expressed to the occupational therapists and the regional coordinator for the Swedish

Association of Visually Impaired Youth that helped selecting the participants. This study was

financially supported by the Swedish National Association for Disabled Children and

Adolescents (RBU) and Luleå University of Technology.

12

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Playground Accessibility and Usability for Children … › smash › get › diva2:1077678 › ...overall aim of this thesis to identify and explore aspects of playground accessibility